The Management of Combined Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Particularly Complex Challenge, Especially in the Elderly

Anticoagulation is superior to dual antiplatelet therapy (DAPT) in the prevention of thromboembolic events in patients with atrial fibrillation (AF), otherwise the prevention of ischemic risk and stent thrombosis after percutaneous coronary intervention (PCI) is warranted by DAPT. The coexistence of...

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Main Authors: Leonardo Bencivenga, Klara Komici, Graziamaria Corbi, Antonio Cittadini, Nicola Ferrara, Giuseppe Rengo
Format: Article
Language:English
Published: Frontiers Media S.A. 2018-07-01
Series:Frontiers in Physiology
Subjects:
Online Access:https://www.frontiersin.org/article/10.3389/fphys.2018.00876/full
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author Leonardo Bencivenga
Klara Komici
Graziamaria Corbi
Antonio Cittadini
Nicola Ferrara
Nicola Ferrara
Giuseppe Rengo
Giuseppe Rengo
author_facet Leonardo Bencivenga
Klara Komici
Graziamaria Corbi
Antonio Cittadini
Nicola Ferrara
Nicola Ferrara
Giuseppe Rengo
Giuseppe Rengo
author_sort Leonardo Bencivenga
collection DOAJ
description Anticoagulation is superior to dual antiplatelet therapy (DAPT) in the prevention of thromboembolic events in patients with atrial fibrillation (AF), otherwise the prevention of ischemic risk and stent thrombosis after percutaneous coronary intervention (PCI) is warranted by DAPT. The coexistence of conditions requiring combined antithrombotic therapies is becoming an increasing relevant clinical problem, whose therapeutic management has long been found in the medical experience rather than in guidelines and consensus. Recently, updates in guidelines and relevant studies have been published in order to better clarify the best management of combined antithrombotic therapy. In the present review, we have analyzed the recent literature, underlining the progresses and the residual limits of the most up-to-date evidence on the management of patients requiring dual or triple antithrombotic therapy, due to coexisting AF and coronary artery disease. An in-depth overview is also focused on the management of antithrombotic therapy in the elderly patient, which represents an even more complex challenge for the clinician. This is due to the high prevalence, among over 65 years aged people, of conditions requiring association of antiplatelet and anticoagulant drugs, the numerous comorbidities, the higher risk of complications, such as bleedings, and the lack of specific evidence, especially for the frail elderly. Nowadays, triple therapy [oral anticoagulation (OAC) plus dual antiplatelet agents] for the shortest possible time should be the treatment for AF patients undergoing PCI, whereas dual therapy (single antiplatelet plus OAC) may be preferred for patients at high bleeding risk.
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spelling doaj.art-23d425ecdd754e37bce62652248a555f2022-12-22T00:31:47ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2018-07-01910.3389/fphys.2018.00876382911The Management of Combined Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Particularly Complex Challenge, Especially in the ElderlyLeonardo Bencivenga0Klara Komici1Graziamaria Corbi2Antonio Cittadini3Nicola Ferrara4Nicola Ferrara5Giuseppe Rengo6Giuseppe Rengo7Department of Translational Medical Sciences, University of Naples Federico II, Naples, ItalyDepartment of Medicine and Health Sciences, University of Molise, Campobasso, ItalyDepartment of Medicine and Health Sciences, University of Molise, Campobasso, ItalyDepartment of Translational Medical Sciences, University of Naples Federico II, Naples, ItalyDepartment of Translational Medical Sciences, University of Naples Federico II, Naples, ItalyIstituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), Telese Terme, ItalyDepartment of Translational Medical Sciences, University of Naples Federico II, Naples, ItalyIstituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), Telese Terme, ItalyAnticoagulation is superior to dual antiplatelet therapy (DAPT) in the prevention of thromboembolic events in patients with atrial fibrillation (AF), otherwise the prevention of ischemic risk and stent thrombosis after percutaneous coronary intervention (PCI) is warranted by DAPT. The coexistence of conditions requiring combined antithrombotic therapies is becoming an increasing relevant clinical problem, whose therapeutic management has long been found in the medical experience rather than in guidelines and consensus. Recently, updates in guidelines and relevant studies have been published in order to better clarify the best management of combined antithrombotic therapy. In the present review, we have analyzed the recent literature, underlining the progresses and the residual limits of the most up-to-date evidence on the management of patients requiring dual or triple antithrombotic therapy, due to coexisting AF and coronary artery disease. An in-depth overview is also focused on the management of antithrombotic therapy in the elderly patient, which represents an even more complex challenge for the clinician. This is due to the high prevalence, among over 65 years aged people, of conditions requiring association of antiplatelet and anticoagulant drugs, the numerous comorbidities, the higher risk of complications, such as bleedings, and the lack of specific evidence, especially for the frail elderly. Nowadays, triple therapy [oral anticoagulation (OAC) plus dual antiplatelet agents] for the shortest possible time should be the treatment for AF patients undergoing PCI, whereas dual therapy (single antiplatelet plus OAC) may be preferred for patients at high bleeding risk.https://www.frontiersin.org/article/10.3389/fphys.2018.00876/fullantithrombotic therapyanticoagulationantiplateletatrial fibrillationpercutaneous coronary interventionelderly
spellingShingle Leonardo Bencivenga
Klara Komici
Graziamaria Corbi
Antonio Cittadini
Nicola Ferrara
Nicola Ferrara
Giuseppe Rengo
Giuseppe Rengo
The Management of Combined Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Particularly Complex Challenge, Especially in the Elderly
Frontiers in Physiology
antithrombotic therapy
anticoagulation
antiplatelet
atrial fibrillation
percutaneous coronary intervention
elderly
title The Management of Combined Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Particularly Complex Challenge, Especially in the Elderly
title_full The Management of Combined Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Particularly Complex Challenge, Especially in the Elderly
title_fullStr The Management of Combined Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Particularly Complex Challenge, Especially in the Elderly
title_full_unstemmed The Management of Combined Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Particularly Complex Challenge, Especially in the Elderly
title_short The Management of Combined Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Particularly Complex Challenge, Especially in the Elderly
title_sort management of combined antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention a particularly complex challenge especially in the elderly
topic antithrombotic therapy
anticoagulation
antiplatelet
atrial fibrillation
percutaneous coronary intervention
elderly
url https://www.frontiersin.org/article/10.3389/fphys.2018.00876/full
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