Use of Anticoagulant Therapy in Patients with Acute Myocardial Infarction and Atrial Fibrillation

Abstract

The incidence of atrial fibrillation (AF) in acute coronary syndrome (ACS) ranges from 2.3–23%. This difference in the incidence of AF is explained by the different ages of the patients in different studies and the different times of application of both reperfusion and drug therapies in acute myocardial infarction (AMI). About 6–8% of patients who underwent percutaneous intervention within AMI have an indication for oral anticoagulant therapy with vitamin K antagonists or new oral anticoagulants (NOAC).The use of oral anticoagulant therapy should be consistent with individual risk of bleeding as well as ischemic risk. Both HAS-BLED and CHA2DS2VASc scores are most commonly used for risk assessment. Except in patients with mechanical valves and antiphospholipid syndrome, NOACs have an advantage over vitamin K antagonists (VKAs). One of the advantages of NOACs is the use of fixed doses, where there is no need for successive INR controls, which increases the patient’s compliance in taking these drugs. The use of triple therapy in ACS is indicated in the case of patients with AF, mechanical valves as well as venous thromboembolism. The results of the studies showed that when choosing a P2Y12 receptor blocker, less potent P2Y12 blockers such as Clopidogrel should be chosen, due to the lower risk of bleeding. It has been proven that the presence of AF within AMI is associated with a higher degree of reinfarction, more frequent stroke, high incidence of heart failure, and there is a correlation with an increased risk of sudden cardiac death. With the appearance of AF in ACS, its rapid conversion into sinus rhythm is necessary, and in the last resort, good control of heart rate in order to avoid the occurrence of adverse clinical events.

Changes in Antithrombotic Therapy Prescription in Patients with a Combination of Atrial Fibrillation and Myocardial Infarction in a Specialised Inpatient Department from 2016–2019 and Associations with Prognosis

“…However, the received changes in ATT prescription for patients with AF and MI at that time, especially the increase in TATT prescription, should be regarded positively as a result of a long and gradual implementation of the ongoing clinical recommendations at that time (2016), in which is stated that “in patients with AF and atrial flutter at risk of stroke and acute coronary syndrome undergoing PCI, TATT is recommended to be extended up to 6 months after PCI” [ 4 ]. In the same recommendations, it is indicated that a high risk of bleeding is compared with the risk of recurrent acute coronary syndrome or stent thrombosis, and it is possible to reduce the duration of TATT to 1 month.…”

“…In the same recommendations, it is indicated that a high risk of bleeding is compared with the risk of recurrent acute coronary syndrome or stent thrombosis, and it is possible to reduce the duration of TATT to 1 month. Dual therapy of OAC with aspirin or clopidogrel may be considered in certain cases, especially for patients who have not undergone stenting [ 4 ]. A similar fact of gradual implementation of clinical recommendations is shown in other works [ 27 , 31 ].…”

“…Further, 14–18% of patients with AF have had MI in the past [ 2 ]. From 2.3% to 21% of patients with acute MI have constant or paroxysmal AF in past medical history [ 3 , 4 ]. Another 2–25% of patients without preceding AF will develop it during or after acute MI [ 3 ].…”