Author + information
- Received November 30, 2018
- Revision received January 22, 2019
- Accepted February 4, 2019
- Published online July 29, 2019.
- Freek W.A. Verheugt, MD, PhDa,∗ (, )@olvg,
- Jurriën M. ten Berg, MD, PhDb,
- Robert F. Storey, MDc,
- Thomas Cuisset, MDd and
- Christopher B. Granger, MDe
- aDepartment of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
- bDepartment of Cardiology, Sint-Antonius Ziekenhuis, Nieuwegein, the Netherlands
- cDepartment of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom
- dDepartment of Cardiology, Timone University Hospital Center, Marseille, France
- eDuke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Freek W.A. Verheugt, Heartcenter, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC Amsterdam, the Netherlands.
• Approximately 30% of AF patients have coexisting CAD, wherein most patients need oral anticoagulant agents combined with antiplatelet drugs leading to excess bleeding complications.
• Both ACS and PCI make more intensified antiplatelet strategies necessary, and these regimens further increase bleeding risk, especially in patients with coexisting AF.
• Future options for these patients include low-dose oral anticoagulation in stable CAD or after DAPT cessation. Dropping aspirin after PCI in AF may also be a future approach.
For secondary prevention of coronary artery disease (CAD), oral antiplatelet therapy is essential. In case of coronary intervention, temporary dual antiplatelet therapy is mandatory as well. Recently, low-dose oral anticoagulation has entered the CAD arena. Atrial fibrillation (AF) is often seen in CAD and vice versa. In most patients stroke prevention in AF consists of oral anticoagulation. In many cases of CAD in patients with AF, anticoagulation has to be combined with antiplatelet agents (so called, dual pathway antithrombotic therapy). Excess bleeding in these conditions is a rapidly rising problem. This review addresses the antithrombotic options in CAD alone, in AF alone, and in their combination, when either an invasive or a noninvasive approach has been chosen.
- antiplatelet therapy
- atrial fibrillation
- coronary artery disease
- oral anticoagulant agents
- percutaneous coronary intervention
Dr. Verheugt has received honoraria for consulting and presentations from Bayer HealthCare, AstraZeneca, Eli Lilly, and Daiichi-Sankyo. Dr. ten Berg has received research grants from ZorgOnderzoek Medische Wetenschappen (ZonMW) and AstraZeneca; and has received honoraria for consulting, presentations, and Advisory Board membership from AstraZeneca, Eli Lilly, Daiichi-Sankyo, The Medicines Company, Accumetrics, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Bayer Healthcare, and Ferrer. Dr. Storey has received institutional research grants from AstraZeneca and PlaqueTec; and has received consultancy fees and/or honoraria from AstraZeneca, Avacta, Bayer, Bristol-Myers Squibb/Pfizer, Idorsia, Haemonetics, Novartis, PlaqueTec, and Thromboserin. Dr. Cuisset has received consulting fees from AstraZeneca and Sanofi; and has received honoraria for lecturing from AstraZeneca, Boston Scientific, Sanofi, and Terumo. Dr. Granger has received research grants from GlaxoSmithKline, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Daiichi-Sankyo, Janssen, Bayer, Novartis, Medtronic Foundation, and Merck & Co.; and has received personal fees from GlaxoSmithKline, Boehringer Ingelheim, Bristol-Myers Squibb, Boston Scientific, Pfizer, Janssen, Bayer, Hoffmann-La Roche, Eli Lilly, AstraZeneca, Daiichi-Sankyo, Rho Pharmaceuticals, Sirtex, Verseon, Gilead, Novo Nordisk, and Medtronic.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 30, 2018.
- Revision received January 22, 2019.
- Accepted February 4, 2019.
- 2019 American College of Cardiology Foundation
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