Conclusiones y recomendaciones prácticas

Patients with atrial fibrillation should be treated with oral anticoagulant drugs to lower their cardioembolic risk. Moreover, if they are to undergo percutaneous coronary intervention, they should receive dual antiplatelet therapy to reduce the incidence of stent thrombosis. Therefore, these patients should be treated with both an oral anticoagulant and an antiplatelet agent. This regimen markedly reduces the risk of thromboembolic events, but is associated with a substantial increase in hemorrhagic complications. Reliable information is available on embolic, hemorrhagic and ischemic risks and on the benefit and potential complications of anticoagulation and antiaggregation in different clinical scenarios. However, percutaneous coronary intervention in these patients raises a number of very specific issues. In addition, the recent publications of studies that have evaluated particular direct oral anticoagulants (i.e. rivaroxaban, dabigatran and apixaban) have provided new information that could significantly alter treatment in these patients. Some of the main topics for debate are whether dual antithrombotic therapy is necessary, whether triple therapy may be preferable, which patients should be treated and for how long, and which antiaggregants should be added. This article highlights the most important evidence-based findings and outlines a number of recommendations, with the aim of identifying the most practical clinical approach in this complex scenario.

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.