Intervención coronaria percutánea y anticoagulantes orales

Patients on long-term oral anticoagulation therapy who are scheduled to undergo a percutaneous coronary intervention are a high-risk population with a large number of comorbid conditions. This is a growing population that has a complicated prognosis because ischemic and bleeding events can occur over the short, medium and long term. Antithrombotic therapy, without doubt a key consideration in these patients, could have a substantial impact on prognosis. Maintenance therapy with oral anticoagulants is also a priority. Over the last few years, several antithrombotic regimens have been investigated with the principle aim of reducing hemorrhagic events while maintaining efficacy. To this end, studies have focused on: (i) shortening the duration of the dual antiplatelet therapy added to anticoagulation; and (ii) the use of antiplatelet monotherapy, particularly clopidogrel, along with an oral anticoagulant. Recently, the emergence of direct oral anticoagulants has generated great hope and excitement. These new drugs, which have a better safety profile than dicoumarinic anticoagulants, could produce substantial prognostic improvements in this context. The results of three clinical trials of direct oral anticoagulants in these highly complex patients are currently available. Their findings, together with another trial that is now in the follow-up phase, have the potential to substantially modify our usual clinical practice in coming years.

Supplement information: this article is part of a supplement entitled “Treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention: an update”, which is sponsored by Boehringer Ingelheim.