Antithrombotic therapy for patients with an indication for oral anticoagulation undergoing percutaneous coronary intervention with stent: The case of venous thromboembolism

2018 ◽  
Vol 269 ◽  
pp. 75-79
Author(s):  
Letizia Riva ◽  
Walter Ageno ◽  
Giuseppe Di Pasquale ◽  
Giancarlo Agnelli ◽  
Andrea Rubboli
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Venous Thromboembolism ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Coronary Intervention ◽  
Percutaneous Coronary

scholarly journals Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2018 ◽  
Vol 138 (5) ◽  
pp. 527-536 ◽  
Author(s):  
Dominick J. Angiolillo ◽  
Shaun G. Goodman ◽  
Deepak L. Bhatt ◽  
John W. Eikelboom ◽  
Matthew J. Price ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulant ◽  
Coronary Intervention ◽  
Vitamin K Antagonist ◽  
Percutaneous Coronary ◽  
Antithrombotic Management

The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non–vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y 12 inhibitor) by the time of hospital discharge should be considered for most patients, whereas extending the use of aspirin beyond hospital discharge (ie, triple therapy) should be considered only for selected patients at high ischemic/thrombotic and low bleeding risks and for a limited period of time. The present document provides a focused updated on the rationale for the new expert consensus–derived recommendations on the antithrombotic management of patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention.

scholarly journals Percutaneous Coronary Intervention in Patients Who Have an Indication for Oral Anticoagulation – an Evidence-based Approach to Antithrombotic Therapy

2015 ◽  
Vol 10 (1) ◽  
pp. 16
Author(s):  
Sean Gallagher ◽  
R Andrew Archbold ◽  
◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Triple Therapy ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Clinical Decision Making ◽  
Oral Anticoagulants ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Stent Deployment ◽  
Percutaneous Coronary

Dual antiplatelet therapy (DAPT) is required following percutaneous coronary intervention (PCI) to prevent stent thrombosis. The optimal antithrombotic therapy following PCI for patients with an indication for long-term oral anticoagulation (OAC) is uncertain. DAPT and OAC, a combination known as ‘triple therapy’, reduces cardiovascular event rates but is associated with a substantial risk of bleeding. Recent data suggest that the duration of DAPT (and thereby triple therapy in those who also require OAC) can be limited to 1–3 months following newgeneration drug-eluting stent deployment, and that aspirin may be omitted from triple therapy, without increasing the rate of ischaemic cardiovascular events. The increasing use of non-vitamin K antagonist oral anticoagulants and new antiplatelet agents (prasugrel and ticagrelor) has further complicated antithrombotic prescribing. This article aims to provide a summary of the evidence regarding antithrombotic therapy after PCI in patients who have an indication for OAC and to provide a framework to aid clinical decision-making in this area.

scholarly journals Antithrombotic Therapy in Complex Percutaneous Coronary Intervention Patients Requiring Chronic Anticoagulation

2021 ◽  
Vol 15 ◽  
Author(s):  
Despoina-Rafailia Benetou ◽  
Panayotis K Vlachakis ◽  
Charalampos Varlamos ◽  
Dimitrios Alexopoulos
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Randomized Trials ◽  
Coronary Intervention ◽  
Antithrombotic Treatment ◽  
Percutaneous Coronary ◽  
Complex Percutaneous Coronary Intervention ◽  
Triple Antithrombotic Therapy ◽  
Optimal Treatment Strategy

The optimal antithrombotic treatment in patients receiving oral anticoagulation undergoing percutaneous coronary intervention (PCI) has been a field of intensive research. Although triple antithrombotic therapy had been, until lately, the strategy of choice, recent evidence points to the superiority of dual antithrombotic therapy regarding bleeding prevention, without significantly compromising efficacy. In the further challenging scenario of complex PCI, associated with a higher ischemic risk, the efficacy of an aspirin-free strategy, adopted shortly after the index event is under question, rendering decision-making a fairly difficult scenario for clinicians. Since patients with an indication for oral anticoagulation undergoing complex PCI are underrepresented in randomized trials, there are scarce data regarding the optimal treatment strategy in such patients. This review aims to analyze and compare different approaches regarding the type and duration of antithrombotic regimens, focusing on both safety and efficacy outcomes, as well as to discuss recent guidelines’ suggestions regarding the therapeutic approach in patients receiving oral anticoagulation undergoing PCI procedures of increased complexity.

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