Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation

Cannon, Christopher P.; Bhatt, Deepak L.; Oldgren, Jonas; Lip, Gregory Y.H.; Ellis, Stephen G.; Kimura, Takeshi; Mæng, Michael; Merkely, Béla; Zeymer, Uwe; Gropper, Savion; Nordaby, Matias; Kleine, Eva; Harper, Ruth; Manassie, Jenny; Januzzi, James L.; Berg, Jürrien M. ten; Steg, Ph. Gabriel; Hohnloser, Stefan H.

doi:10.1056/nejmoa1708454

Cited by 1,162 publications

(1,107 citation statements)

References 27 publications

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“…Отмечено недостоверное повышение уровня отдельных тромбоэмболических конеч-ных точек в группе двойной терапии с дабигат-раном в дозе 110 мг (2 раза в сутки), однако, по мнению авторов, данные результаты следует оценивать с осторожностью вследствие недоста-точной доказательности. Тем не менее проде-монстрировано существенное уменьшение час-тоты кровотечений при использовании двойной терапии [39].…”

Section: антитромботическая терапия после острого коронарного синдромunclassified

Aspects of antithrombotic therapy in patients with atrial fibrillation and coronary disease

Bockeria¹,

Gafurov²

2018

Ann aritmol

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Section: антитромботическая терапия после острого коронарного синдромunclassified

Aspects of antithrombotic therapy in patients with atrial fibrillation and coronary disease

Bockeria¹,

Gafurov²

2018

Ann aritmol

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“…Subsequently, with the introduction and prevalent use of direct oral anticoagulants, PIONEER AF-PCI 87 used rivaroxaban and REDUAL-PCI 88 used dabigatran to evaluate the safety and efficacy of triple therapy exclusively in AF patients undergoing PCI.…”

Section: Table 8 Evidence On Tripple Therapymentioning

confidence: 99%

“…The results from REDUAL-PCI 88 were presented at American Heart Association Annual Scientific Sessions (AHA 2017), Anaheim, CA, November 14, 2017. In this trial, AF patients undergoing PCI were randomized in 1:1:1 fashion to dual therapy with dabigatran at a dose of 110 mg (n = 981) vs. dual therapy with dabigatran at a dose of 150 mg (n = 763) vs. triple therapy with warfarin (n = 981).…”

Section: Table 8 Evidence On Tripple Therapymentioning

confidence: 99%

Dual Antiplatelet Therapy (DAPT) in Coronary Artery Disease: A Daunting Dilemma

Chaturvedula¹,

Diver²,

Vashist³

2018

Preprint

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Percutaneous coronary intervention(PCI) with stenting for the treatment of acute coronary syndrome(ACS) is the contemporary standard of care. Such treatment is followed by Dual anti-platelet therapy(DAPT) comprising of aspirin and a P2Y12 inhibitor. The efficacy of this therapy has been well established but the optimal duration of DAPT remains elusive, and has thus far attracted a prodigious deal of scientific attention. Decision regarding DAPT duration can be challenging clinically in the modern era with the evolution of newer stents, more potent antiplatelet agents and novel anticoagulant drugs in addition to an older patient population with multiple comorbidities. Major societal guidelines have emphasized comprehensive assessment of ischemic and bleeding risk, in turn recommending individualization of DAPT duration, thus encouraging "shared decision making". The following review is aimed at critically evaluating the available evidence to help make these crucial clinical decisions regarding duration of DAPT and triple therapy.

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“…[4][5][6] The presence of AF requires anti-coagulant therapy for the prevention of strokes, although anticoagulant drug administration plus dual anti-platelet therapy after percutaneous coronary intervention would increase the risk of bleeding and a variety of clinical trials have been conducted to evaluate alternative regimens. 7,8) Hence, the prediction and prevention of atrial fibrillation as a complication of AMI could be a meaningful strategy. In patients with left ventricular dysfunction secondary to AMI, treatment with an angiotensinconverting-enzyme (ACE) inhibitor could reduce the incidence of AF in the chronic phase.…”

mentioning

confidence: 99%

Can Anti-inflammatory Therapy Prevent Atrial Fibrillation in Myocardial Infarction Patients?

Nakayama

Fujiu

2018

Int. Heart J.

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C ardiovascular diseases still remain one of the greatest health challenges. While the incidence and case-fatality rate of acute myocardial infarction (AMI) have decreased with the development of medications and reperfusion therapy, the disease burden of complications has increased. 1) Arrhythmia in the setting of AMI is an adverse prognostic factor, and atrial fibrillation (AF), the most frequent supraventricular arrhythmia, is associated with the increased risk of short-term and longterm mortality.2,3) In addition, AMI patients with AF have more comorbidities as compared to patients in sinus rhythm, which relate to a higher re-infarction rate, higher stroke rate, and higher risk for heart failure. [4][5][6] The presence of AF requires anti-coagulant therapy for the prevention of strokes, although anticoagulant drug administration plus dual anti-platelet therapy after percutaneous coronary intervention would increase the risk of bleeding and a variety of clinical trials have been conducted to evaluate alternative regimens. 7,8) Hence, the prediction and prevention of atrial fibrillation as a complication of AMI could be a meaningful strategy. In patients with left ventricular dysfunction secondary to AMI, treatment with an angiotensinconverting-enzyme (ACE) inhibitor could reduce the incidence of AF in the chronic phase. 9) Carvedilol has been shown to suppress AF and atrial flutter in a similar patient population, according to a sub-analysis in the the CAPRI-CORN study.10) Additionally, atorvastatin significantly reduced the incidence of postoperative AF after elective cardiac surgery.11,12) However, there is limited evidence suggesting that upstream medical therapy reduces the incidence of AF as primary endpoint.13) It is deemed desirable to provide preventive therapy tailored to risk stratification with respect to new-onset AF associated with AMI. Article p.64Zhang, et al. investigated the expression of Toll like receptors (TLRs) on the surface of peripheral blood mononuclear cells (PBMCs) in AMI patients. 14) They collected blood samples before any reperfusion therapy within two hours after AMI onset, and divided the clinical subjects into two groups: patients with new-onset AF in 1 month after AMI (AFMI group) or without (MI group). The results showed that the expressions of both TLR2 and TLR4 in PBMCs in the MI group were higher than that in healthy volunteers, and much higher in PBMCs in the AFMI group. Protein assay and flow cytometry analysis also showed a significant difference in TLR2 and TLR4 expression. With respect to the TLR adaptor proteins, myeloid differentiation factor 88 (MyD88) and TIR domain-containing protein-β antibody (TRIF-β), their protein levels were significantly higher in the AFMI group than in the MI group as well, indicating that the TLR2 and TLR4 pathway was surely augmented in PBMCs in the AFMI group. Of note, these differences were already found in the very rapid phase of AMI onset.Evidence to support the involvement of the inflammatory process in the pathophysiology of AF has...

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Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation

Cited by 1,162 publications

References 27 publications

Aspects of antithrombotic therapy in patients with atrial fibrillation and coronary disease

Aspects of antithrombotic therapy in patients with atrial fibrillation and coronary disease

Dual Antiplatelet Therapy (DAPT) in Coronary Artery Disease: A Daunting Dilemma

Can Anti-inflammatory Therapy Prevent Atrial Fibrillation in Myocardial Infarction Patients?

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