title: Atrial fibrillation and coronary artery disease: which antithrombotic treatment strategy?
abstract: OBJECTIVE
  The optimal antithrombotic therapy in patients with atrial fibrillation and coronary artery disease is controversial. The benefit of the combination of antithrombotic therapies remains debatable, and, as the bleeding risk is substantial, this calls for knowledge of the duration, and which and how many agents should be used.
  
  
  RESULTS
  The first randomized trial to challenge current recommendations of triple therapy (oral anticoagulation plus clopidogrel plus aspirin) examined patients on warfarin undergoing percutaneous coronary intervention with stent implantation. A reduced risk of any bleeding (hazard ratio 0.36) was found with combination of clopidogrel compared with triple therapy without increasing major cardiovascular events. In real-life patients, a nationwide Danish registry supported these findings, and, relative to triple therapy, no significant difference was found for recurrent myocardial infarction when adding only clopidogrel (hazard ratio 0.69) or aspirin (hazard ratio 0.96) to vitamin K antagonist. However, the latter regimen was associated with significantly increased risk of death.
  
  
  CONCLUSIONS
  Within 1 year after myocardial infarction and/or percutaneous coronary intervention in patients with atrial fibrillation, current consensus papers endorse use of dual antiplatelet therapy on top of oral anticoagulation. A regimen consisting of oral anticoagulation and clopidogrel (without aspirin) could provide an alternative from a benefit and safety perspective.
authors.affiliation: aDepartment of Cardiology, Gentofte University Hospital, Hellerup, Copenhagen, Denmark bDepartment of Cardiology, Amphia Hospital, Breda, the Netherlands.
authors.forename: Morten
authors.initials: M
authors.lastname: Lamberts
authors.forename: Willem
authors.initials: W
authors.lastname: Dewilde
authors.forename: Morten Lock
authors.initials: ML
authors.lastname: Hansen
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D015912:Thrombolytic Therapy / Q000592:standards*
chemical_list: D005343:Fibrinolytic Agents