title: Unanswered questions in patients with concurrent atrial fibrillation and acute coronary syndrome.
abstract: The best regimen for the long-term management of patients with atrial fibrillation who present with an acute coronary syndrome or require placement of a coronary stent remains unclear. Clinicians need to understand the risk of stroke, stent thrombosis, and major bleeding associated with treating these patients. Numerous studies and risk assessment schemes provide clinicians with an estimation of the risk of stroke, stent thrombosis, and major bleeding that may be associated with the use or avoidance of dual antiplatelet therapy with concurrent anticoagulation therapy (triple therapy). This review discusses the special antithrombotic needs in patients who have atrial fibrillation and either acute coronary syndrome or a requirement for percutaneous coronary intervention, including the published evidence for non-vitamin K oral anticoagulants, and the unanswered questions in this patient population. In conclusion, until the results of additional ongoing or planned randomized trials are known, clinicians must continue to rely on expert opinion and their own clinical judgment when treating these patients.
authors: Division of Cardiovascular Diseases, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Jefferson Medical College, Philadelphia, Pennsylvania. Electronic address: iced@mlhs.org.
authors: Daniel S
authors: DS
authors: Ice
authors: Division of Cardiovascular Diseases, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Jefferson Medical College, Philadelphia, Pennsylvania.
authors: Timothy A
authors: TA
authors: Shapiro
authors: Division of Cardiovascular Diseases, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Jefferson Medical College, Philadelphia, Pennsylvania.
authors: Eric M
authors: EM
authors: Gnall
authors: Division of Cardiovascular Diseases, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Jefferson Medical College, Philadelphia, Pennsylvania.
authors: Peter R
authors: PR
authors: Kowey
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000453:epidemiology*; D000925:Anticoagulants; D001241:Aspirin / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology*; D000077144:Clopidogrel; D015897:Comorbidity; D004359:Drug Therapy, Combination; D065427:Factor Xa Inhibitors; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D018570:Risk Assessment; D000069552:Rivaroxaban; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013876:Thiophenes / Q000627:therapeutic use; D013927:Thrombosis / Q000150:complications / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; C522181:apixaban; D000069552:Rivaroxaban; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin