Choice of antiplatelet/anticoagulation treatmentafter acute coronary syndrome in patients with atrial fibrillationDownload in PDF
Atrial fibrillation that frequently occurs in patients with acutecoronary syndrome significantly increases the risk of ischemicstroke and other outcomes and requires long-term anticoagu-lation. Novel oral anticoagulants (NOAC) are preferred treat-ment option given their advantages in efficacy, safety andconvenience of use over vitamin K antagonists. Within thefirst 12 months after acute coronary syndome ± coronarystenting, NOAC should be given in combination with one ortwo antiplatelet agents. The duration of triple antithrombotictherapy should not exceed 6 months, particularly in patientswith a high risk of bleedings. Dual antithrombotic treatmentwith rivaroxaban in reduced dose of 15 mg once daily and clopidogrel 75 mg daily is as effective as triple antithrombotictherapy but is associated with a lower risk of bleedings.However, antithrombotic treatment within the first year afteracute coronary syndome should be carefully chosen on case bycase basis, taking into account the risk of ischemic events,particularly stent thrombosis, and bleedings. Patients withstable coronary artery disease should be treated only with NOAC.
Atrial fibrillation, acute coronary syndrome,novel oral anticoagulants.