title: Antithrombotics in atrial fibrillation and coronary disease.
abstract: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and approximately 18-45% of AF patients have concomitant coronary artery disease (CAD). Several studies have demonstrated that oral anticoagulation is the mainstay of therapy for stroke prevention in AF. Similarly, antiplatelet therapy including aspirin and P2Y12 inhibitor is recommended in the management of acute coronary syndrome and stable CAD. Despite the high prevalence of CAD with AF, practice guidelines are scarce on the appropriate antithrombotic regimen due to lack of large-scale randomized clinical trials. The use of direct thrombin and factor Xa inhibitors for stroke prevention in AF has also complicated the possible combinations of antithrombotic therapies. This review aims to discuss the available evidence regarding aspirin as an antithrombotic strategy, the role of novel anticoagulants and the specific clinical situations where aspirin may be beneficial in patients with AF and CAD.
authors.affiliation: Department of Cardiovascular Medicine, University of Missouri-Columbia, School of Medicine, Columbia, MO, USA.
authors.forename: Poonam
authors.initials: P
authors.lastname: Velagapudi
authors.forename: Mohit K
authors.initials: MK
authors.lastname: Turagam
authors.forename: Harsh
authors.initials: H
authors.lastname: Agrawal
authors.forename: Mayank
authors.initials: M
authors.lastname: Mittal
authors.forename: Abraham G
authors.initials: AG
authors.lastname: Kocheril
authors.forename: Kul
authors.initials: K
authors.lastname: Aggarwal
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000991:Antithrombins / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D003324:Coronary Artery Disease / Q000188:drug therapy*; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: antithrombotic; aspirin; atrial fibrillation; coronary artery disease; novel anticoagulants; warfarin