Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes: results of the European Heart Rhythm Association survey


Lane, Deirdre A ORCID: 0000-0002-5604-9378, Dagres, Nikolaos, Dan, Gheorghe-Andrei, Garcia Seara, Javier, Iliodromitis, Konstantinos, Lenarczyk, Radoslaw, Lip, Gregory YH ORCID: 0000-0002-7566-1626, Mansourati, Jacques, Marin, Francisco, Scherr, Daniel et al (show 1 more authors) (2019) Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes: results of the European Heart Rhythm Association survey. EUROPACE, 21 (7). pp. 1116-1125.

[img] Text
Management of ACS in patients with AF_ACCEPTED.pdf - Author Accepted Manuscript
Download (595kB)

Abstract

The management of an acute coronary syndrome (ACS) in a patient with existing atrial fibrillation (AF) often presents a management dilemma both in the acute phase and post-ACS, since the majority of AF patients will already be receiving oral anticoagulation (OAC) for stroke prevention and will require further antithrombotic treatment to reduce the risk of in-stent thrombosis or recurrent cardiac events. Current practice recommendations are based largely on consensus option as there is limited evidence from randomized controlled trials. Prior to the launch of the new European Heart Rhythm Association (EHRA) consensus document, a survey was undertaken to examine current clinical management of these patients across centres in Europe. Forty-seven centres submitted valid responses, with the majority (70.2%) being university hospitals. This EHRA survey demonstrated overall the management of ACS in AF patients is consistent with the available guidance. Most centres would use triple therapy for a short duration (4 weeks) and predominantly utilize a strategy of OAC (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) plus aspirin and clopidogrel, followed by dual therapy [(N)OAC plus clopidogrel] until 12 months post-percutaneous coronary intervention, followed by (N)OAC monotherapy indefinitely. Where NOAC was used in combination with antiplatelet(s), the lower dose of the respective NOAC was preferred, in accordance with current recommendations.

Item Type: Article
Uncontrolled Keywords: Atrial fibrillation, Acute coronary syndrome, Anticoagulation, Dual antiplatelets, Non-vitamin antagonist oral anticoagulants, Triple therapy, Vitamin K antagonist, EHRA survey
Depositing User: Symplectic Admin
Date Deposited: 21 Mar 2019 10:54
Last Modified: 19 Jan 2023 00:56
DOI: 10.1093/europace/euz033
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3034578
Dimensions
Altmetric
CORE (COnnecting REpositories)