Abstract

ARRUFAT-SANCHEZ, Marta et al. Antithrombotic treatment in patients with atrial fibrillation after percutaneous coronary intervention, a difficult balance to achieve. JONNPR [online]. 2022, vol.7, n.2, pp.160-208.  Epub Aug 01, 2022. ISSN 2529-850X.  https://dx.doi.org/10.19230/jonnpr.4435.

The combination of antithrombotic treatment (anticoagulant / antiplatelet) that those who AF patients who have ACS and / or must undergo PCI is unclear. The association of oral anticoagulation with a P2Y 12 inhibitor and aspirin, called triple antithrombotic therapy (TAT) is associated with a high risk of bleeding. On the other hand, dual antithrombotic therapy (DAT) without Aspirin carries a still unknown risk of ischemic events.(1) Treatment must balance the ischemic and hemorrhagic risk reaching an optimal net clinical benefit. The purpose of this review is to establish clearer treatment guidelines in these patients. We analyzed 2 previous observational studies to establish the starting point and 5 RCTs that included a total of 11,532 patients. In them, DAT vs. TAT, in patients with AF who suffer from ACS and / or undergo PCI.

DAT was associated with a lower rate of bleeding compared to TAT without increasing ischemic events. Without However, no trial achieved sufficient statistical power to consistently assess the ischemic efficacy results. Of the different therapies, they showed better efficacy results those that used DAT versus TAT and ACOD versus VKA. Conclusion: In patients with AF who suffer an ACS and / or must undergo PCI, the DAT regimen associates fewer bleeding events, without significant differences regarding ischemic events; The use of ACOD shows a better profile of benefit versus AVK, so they are preferred.

Keywords : antithrombotic treatment; atrial fibrillation; coronary intervention percutaneous.

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