Periprocedural Management and In‐Hospital Outcome of Patients with Indication for Oral Anticoagulation Undergoing Coronary Artery Stenting

Rubboli, Andrea; Colletta, Mauro; Valencia, José; Capecchi, Alessandro; Franco, Nicoletta; Zanolla, Luisa; Vecchia, Luigi La; Piovaccari, Giancarlo; Pasquale, Giuseppe Di

doi:10.1111/j.1540-8183.2009.00468.x

Cited by 50 publications

(25 citation statements)

References 33 publications

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“…9 Despite overlap in the occurrence of these syndromes, the pharmacotherapies used to manage AF and ACS differ. The management of AF patients who undergo stent placement for an ACS is challenging in so far as the risks of AF-related ischemic stroke and bleeding associated with the antithrombotic therapy and stent thrombosis must all be balanced.…”

Section: Introductionmentioning

confidence: 99%

An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin k antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI)

Gibson

Mehran

Bode

et al. 2015

American Heart Journal

151

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Section: Introductionmentioning

confidence: 99%

An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin k antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI)

Gibson

Mehran

Bode

et al. 2015

American Heart Journal

151

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“…It is estimated that about 5% of patients undergoing percutaneous coronary interventions (PCI) has atrial fibrillation or other indications for chronic oral anticoagulant therapy [5]. Since DAPT provides insufficient protection against stroke and thrombotic complications in patients with AF and mechanical aortic valves [6,7], substitution of OAC with DAPT appears not applicable.…”

Section: Introductionmentioning

confidence: 99%

Triple antithrombotic therapy in patients with atrial fibrillation undergoing coronary artery stenting: hovering among bleeding risk, thromboembolic events, and stent thrombosis

Menozzi

Rubboli²,

Manari

et al. 2012

Thrombosis Journal

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Dual antiplatelet treatment with aspirin and clopidogrel is the antithrombotic treatment recommended after an acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients, in whom long-term treatment oral anticoagulation is mandatory, is however scarce. To evaluate the safety and efficacy of the various antithrombotic strategies adopted in this population, we reviewed the available evidence on the management of patients receiving oral anticoagulation, such as a vitamin-k-antagonists, referred for coronary artery stenting.Atrial fibrillation is the most frequent indication for oral anticoagulation. The need of starting antiplatelet therapy in this clinical scenario raises concerns about the combination to choose: triple therapy with warfarin, aspirin, and a thienopyridine being the most frequent and advised. The safety of this regimen appeared suboptimal because of an increased risk in hemorrhagic complications. On the other hand, the combination of oral anticoagulation and an antiplatelet agent is suboptimal in preventing thromboembolic events and stent thrombosis; dual antiplatelet therapy may be considered only when a high hemorrhagic risk and low thromboembolic risk are perceived. Indeed, the need for prolonged multiple-drug antithrombotic therapy increases the bleeding risks when drug eluting stents are used.Since current evidence derives mainly from small, single-center and retrospective studies, large-scale prospective multicenter studies are urgently needed.

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“…1,2 It is estimated that 5-7% of patients undergoing percutaneous coronary interventions (PCI) have AF or other indications for chronic oral anticoagulant therapy. [3][4][5] These patients pose a significant dilemma for the interventional cardiologist because the combination of oral anticoagulants with aspirin and clopidogrel ("triple therapy") during follow-up has been reported to result in an increase risk of major bleeding. 6 Major bleeding is a serious complication that is associated with increased morbidity and mortality particularly when it occurs shortly after a stent procedure.…”

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confidence: 99%

Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Coronary Stenting

Faxon

Eikelboom

Berger

et al. 2011

Circ: Cardiovascular Interventions

126

113

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Abstract-The optimal regimen of the anticoagulant and antiplatelet therapies in patients with atrial fibrillation who have had a coronary stent is unclear. It is well recognized that "triple therapy" with aspirin, clopidogrel, and warfarin is associated with an increased risk of bleeding. National guidelines have not made specific recommendations, given the lack of adequate data. In choosing the best antithrombotic options for a patient, consideration needs to be given to the risks of stroke, stent thrombosis, and major bleeding. This executive summary describes these risks, provides specific recommendations concerning vascular access, stent choice, concomitant use of proton pump inhibitors, and the use and duration of triple therapy after stent placement, based on the risk assessment. (Circ Cardiovasc Interv. 2011;4:522-534.)Key Words: atrial fibrillation Ⅲ antithrombotic therapy Ⅲ warfarin Ⅲ triple therapy Ⅲ stent T he optimal regimen of the anticoagulant and antiplatelet therapies in patients with atrial fibrillation (AF) who have had a coronary stent is unclear. 1,2 It is estimated that 5-7% of patients undergoing percutaneous coronary interventions (PCI) have AF or other indications for chronic oral anticoagulant therapy. 3-5 These patients pose a significant dilemma for the interventional cardiologist because the combination of oral anticoagulants with aspirin and clopidogrel ("triple therapy") during follow-up has been reported to result in an increase risk of major bleeding. 6 Major bleeding is a serious complication that is associated with increased morbidity and mortality particularly when it occurs shortly after a stent procedure. 7,8 In one study among patients on triple therapy with aspirin, clopidogrel, and warfarin, major bleeding occurred in 4.7%, and approximately 50% of these patients died within 6 months. 9 Editorial see p 410The American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ ESC) guidelines have been cautious to recommend triple therapy (aspirin, clopidogrel, and oral anticoagulation) in patients with AF undergoing PCI due to the increased bleeding risk and limited information about the safety and efficacy of this treatment regimen. 10 Currently, the use of triple therapy is classified as a class IIb recommendation (may be considered) with a level of evidence C (expert opinion). 10,11 Recently, the ESC Working Group on Thrombosis published a consensus document on the management of these patients. 12,13 The authors conducted a careful review of the available studies and made a number of specific recommendations that have been supported by the ESC guidelines for the management of AF. 14 They tempered these recommendations since they were largely based on expert opinion. The current document provides a North American view of the issues and is the opinion of select experts in the United States and Canada. Because much of the background information has been previously published in the ESC consensus document, prior studies will not be extensively ...

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Periprocedural Management and In‐Hospital Outcome of Patients with Indication for Oral Anticoagulation Undergoing Coronary Artery Stenting

Cited by 50 publications

References 33 publications

An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin k antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI)

An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin k antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI)

Triple antithrombotic therapy in patients with atrial fibrillation undergoing coronary artery stenting: hovering among bleeding risk, thromboembolic events, and stent thrombosis

Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Coronary Stenting

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