Nonvalvular atrial fibrillation and acute coronary syndrome: Present Indian perspective and assessment

Background: The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy, due to presence of Atrial Fibrillation (AF), has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the trade-off is an increased risk for bleeding while on DAPT. The addition of an anticoagulation further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on anticoagulation (VKA/ NOAC) must be assessed and therapy individualized to ensure optimal therapy for each unique situation. Aims and Objectives: The aim of the study was to determine the diversity in the antiplatelet and anticoagulation treatment of patients with nonvalvular AF or flutter who develop acute coronary syndrome (ACS) or undergo PCI in India.Materials and Methods: All patients who had AF and underwent PCI were included in the study. Results: In the study 100 patients of AF with PCI were evaluated, among who 95 % were started on triple therapy (TT) and 5 % on DAPT. The patients were followed up at 1 month, 3 months, 6 months, and 1 year for adjustment of antiplatelet, anticoagulation medicines, and their dosage. Conclusion: The study reviewed the best practices for the pharmacologic management of patients requiring anticoagulation with NOAC who are treated with PCI and require antiplatelet therapy.