title: Triple therapy for atrial fibrillation and percutaneous coronary intervention.
abstract: OBJECTIVE
  Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) require treatment with oral anticoagulation (OAC) and additional dual antiplatelet therapy with aspirin and clopidogrel (DAPT), i.e. triple therapy. However, triple therapy produces a high annual bleeding risk outweighing the benefits. To improve safety of antithrombotic treatment in these patients, the risks and benefits of all possible treatment options should be evaluated. This review provides an overview of current guidelines and new evidence for optimizing treatment of atrial fibrillation patients with an indication for combined treatment with OAC and DAPT.
  
  
  RESULTS
  To reduce bleeding risks during PCI, new evidence suggests that uninterrupted anticoagulation, radial access and the use of newer-generation drug eluting stent (DES) should be preferred. The use of glycoprotein receptor inhibitors should be avoided. After PCI, omitting aspirin seems to result in less bleeding compared with triple therapy, and the use of proton pump inhibitors further reduces bleeding risk.
  
  
  CONCLUSIONS
  These new strategies seem to further improve the safety of antithrombotic treatment in patients with atrial fibrillation undergoing PCI.
authors.affiliation: aDepartment of Cardiology, St Antonius Hospital, Nieuwegein bDepartment of Cardiology, Amphia Hospital Breda, the Netherlands.
authors.forename: Naoual
authors.initials: N
authors.lastname: Bennaghmouch
authors.forename: Willem J M
authors.initials: WJ
authors.lastname: Dewilde
authors.forename: Jurrien M
authors.initials: JM
authors.lastname: ten Berg
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000628:therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors