The antithrombotic therapy of atrial fibrillation in patients with coronary heart disease

Abstract

Coronary heart disease (CHD) is the most common cardiovascular disease, while atrial fibrillation (AF) is the most common heart rhythm disorder. These diseases have common risk factors such as hypertension, diabetes, sleep apnea, obesity and smoking. The frequency of CHD in patients with AF ranges from 17.0 to 46.5%, while the prevalence of AF among patients with CHD is low and is estimated at only 0.2-5.0%. AF is a well-known factor of unfavorable short-term and long-term prognosis in patients with acute myocardial infarction; it is associated with a significant increase in overall mortality. It is assumed that in 5-15% of cases of AF, coronary artery stenting and, accordingly, triple therapy with Aspirin, Clopidogrel or Ticagrelor and oral anticoagulant will ever be required. This requires very careful consideration of balanced antithrombotic therapy, taking into account the high risk of bleeding, the risk of stroke and stent thrombosis followed by acute coronary syndrome. Co-administration of oral anticoagulants with antiplatelet drugs, and in particular triple therapy, significantly increases the absolute risk of serious bleeding. In addition, severe bleeding is associated with a fivefold increase in the risk of adverse outcome after acute coronary syndrome. The presence of atrial fibrillation with coronary heart disease worsens the prognosis even in patients undergoing careful treatment.