title: Antithrombotic therapy in patients treated with oral anticoagulation undergoing coronary artery stenting. An expert consensus document with focus on atrial fibrillation.
abstract: Dual antiplatelet treatment with aspirin and clopidogrel is recommended after coronary stenting (PCI-S). There is scant evidence defining optimal post-PCI-S antithrombotic therapy in patients with atrial fibrillation (AF) in whom oral anticoagulation (OAC) is mandated. To evaluate the safety and efficacy of the antithrombotic strategies for this population, we conducted a systematic review of the available evidence in patients treated with OAC undergoing PCI-S. AF was the most frequent indication for OAC. Post-PCI-S management was highly variable, and triple therapy with warfarin, aspirin, and clopidogrel was the most frequent and effective combination. Warfarin plus aspirin alone was not sufficiently effective in the early period after PCI-S and should not be prescribed. While acknowledging that the optimal antithrombotic treatment for patients with AF at medium or high thromboembolic risk undergoing PCI-S is currently undefined, triple therapy of warfarin, aspirin, and clopidogrel is currently recommended, although associated with an increased risk of major bleeding. Restrictive use of drug-eluting stent is also recommended, due to the need for prolonged multiple-drug antithrombotic therapy which may increase the bleeding risk. Whether the combination of warfarin and clopidogrel (without aspirin) will preserve efficacy and produce less bleeding is an important issue still needing to be addressed.
authors.affiliation: Division of Cardiology, Cardiac Catheterization Laboratory, Maggiore Hospital, Bologna, Italy. andrearubboli@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
authors.forename: Michael
authors.initials: M
authors.lastname: Buerke
authors.forename: Eric
authors.initials: E
authors.lastname: Eeckhout
authors.forename: Saul B
authors.initials: SB
authors.lastname: Freedman
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Gershlick
authors.forename: Axel
authors.initials: A
authors.lastname: Schlitt
authors.forename: Hung Fat
authors.initials: HF
authors.lastname: Tse
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000601:surgery*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D006801:Humans; D009204:Myocardial Revascularization; D011182:Postoperative Care; D015607:Stents; D013927:Thrombosis / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin