The Choice of Antithrombotic Therapy in a Patient with New-Onset Atrial Fibrillation and High Coronary Thrombotic risk.

Current guidelines are mandatory in the choice of anticoagulant and/or antiplatelet therapy in patients with atrial fibrillation undergoing percutaneous transluminal coronary angioplasty and in patients with coronary artery disease and previous percutaneous transluminal coronary angioplasty that develop atrial fibrillation. However, in the real world there are crossroads with multiple choices, especially taking into account patient's peculiar characteristics and risk factors, which sometimes are not well represented in the guidelines. The reported clinical case focuses on the choice of anticoagulation therapy in a patient with chronic and severe coronary artery disease and new diagnosis of atrial fibrillation who, considering his specifically high coronary thrombotic risk, probably should continue antiplatelet therapy.

[1]  A. Parkhomenko,et al.  Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation , 2019, The New England journal of medicine.

[2]  G. Levine,et al.  ACC/AHA Versus ESC Guidelines on Dual Antiplatelet Therapy: JACC Guideline Comparison. , 2018, Journal of the American College of Cardiology.

[3]  Deepak L. Bhatt,et al.  Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention. , 2018, Circulation.

[4]  P. Kolh,et al.  2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. , 2018, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[5]  Deepak L. Bhatt,et al.  Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation , 2017, The New England journal of medicine.

[6]  Deepak L. Bhatt,et al.  Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials , 2017, The Lancet.

[7]  G. Lip,et al.  Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. , 2016, The New England journal of medicine.

[8]  P. Kirchhof,et al.  2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[9]  Tom Adriaenssens,et al.  Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial , 2013, The Lancet.