Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention

Selection of the optimal peri- and postprocedural antithrombotic regimen in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a common clinical problem which may pose a challenge to medical practitioners. This systematic review summarizes the updated evide...

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Autores principales:	Marek Koziński, Joanna Rejszel-Baranowska, Elżbieta Młodawska, Jolanta M. Siller-Matula, Anna Tomaszuk-Kazberuk
Formato:	article
Lenguaje:	EN
Publicado:	Termedia Publishing House 2020
Materias:	atrial fibrillation percutaneous coronary intervention non-vitamin k oral anticoagulants vitamin k antagonist anticoagulation Medicine R
Acceso en línea:	https://doaj.org/article/db48a90338b94bd7b02c1566ce8d177a
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spelling	oai:doaj.org-article:db48a90338b94bd7b02c1566ce8d177a2021-12-02T18:55:08ZUpdated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention1734-93381897-429510.5114/aic.2020.96055https://doaj.org/article/db48a90338b94bd7b02c1566ce8d177a2020-06-01T00:00:00Zhttps://www.termedia.pl/Updated-overview-of-evidence-on-optimal-antithrombotic-therapy-in-patients-with-atrial-fibrillation-undergoing-percutanous-coronary-intervention,35,40855,1,1.htmlhttps://doaj.org/toc/1734-9338https://doaj.org/toc/1897-4295Selection of the optimal peri- and postprocedural antithrombotic regimen in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a common clinical problem which may pose a challenge to medical practitioners. This systematic review summarizes the updated evidence on this topic. Non-vitamin K oral anticoagulants (NOACs) at standard doses are the preferred option in most of post PCI patients with AF, except those few with a clear indication for a vitamin K antagonist (VKA). Reduced NOAC doses should be considered in dabigatran- or rivaroxaban-treated patients with a high bleeding risk, which prevail over concerns about stent thrombosis or ischemic stroke. There is insufficient evidence to favor one NOAC over another in this setting. In the early post stenting period, triple therapy comprising a NOAC, clopidogrel and aspirin is recommended. Timing of post PCI aspirin cessation should be based on a careful analysis of the bleeding and ischemic risk. There is only low quality evidence regarding the optimal approach to elective or urgent/emergency PCI procedures in patients requiring oral anticoagulation. It is suggested that there is no need of interruption of VKA and PCI procedure should be performed via radial artery access with a lower dose of unfractionated heparin. On the other hand, NOACs are usually stopped before elective PCIs, while urgent/emergency procedures may be performed with the addition of low-dose parenteral anticoagulation.Marek KozińskiJoanna Rejszel-BaranowskaElżbieta MłodawskaJolanta M. Siller-MatulaAnna Tomaszuk-KazberukTermedia Publishing Housearticleatrial fibrillation percutaneous coronary intervention non-vitamin k oral anticoagulants vitamin k antagonist anticoagulationMedicineRENAdvances in Interventional Cardiology, Vol 16, Iss 2, Pp 127-137 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation percutaneous coronary intervention non-vitamin k oral anticoagulants vitamin k antagonist anticoagulation Medicine R
spellingShingle	atrial fibrillation percutaneous coronary intervention non-vitamin k oral anticoagulants vitamin k antagonist anticoagulation Medicine R Marek Koziński Joanna Rejszel-Baranowska Elżbieta Młodawska Jolanta M. Siller-Matula Anna Tomaszuk-Kazberuk Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention
description	Selection of the optimal peri- and postprocedural antithrombotic regimen in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a common clinical problem which may pose a challenge to medical practitioners. This systematic review summarizes the updated evidence on this topic. Non-vitamin K oral anticoagulants (NOACs) at standard doses are the preferred option in most of post PCI patients with AF, except those few with a clear indication for a vitamin K antagonist (VKA). Reduced NOAC doses should be considered in dabigatran- or rivaroxaban-treated patients with a high bleeding risk, which prevail over concerns about stent thrombosis or ischemic stroke. There is insufficient evidence to favor one NOAC over another in this setting. In the early post stenting period, triple therapy comprising a NOAC, clopidogrel and aspirin is recommended. Timing of post PCI aspirin cessation should be based on a careful analysis of the bleeding and ischemic risk. There is only low quality evidence regarding the optimal approach to elective or urgent/emergency PCI procedures in patients requiring oral anticoagulation. It is suggested that there is no need of interruption of VKA and PCI procedure should be performed via radial artery access with a lower dose of unfractionated heparin. On the other hand, NOACs are usually stopped before elective PCIs, while urgent/emergency procedures may be performed with the addition of low-dose parenteral anticoagulation.
format	article
author	Marek Koziński Joanna Rejszel-Baranowska Elżbieta Młodawska Jolanta M. Siller-Matula Anna Tomaszuk-Kazberuk
author_facet	Marek Koziński Joanna Rejszel-Baranowska Elżbieta Młodawska Jolanta M. Siller-Matula Anna Tomaszuk-Kazberuk
author_sort	Marek Koziński
title	Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention
title_short	Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention
title_full	Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention
title_fullStr	Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention
title_full_unstemmed	Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention
title_sort	updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention
publisher	Termedia Publishing House
publishDate	2020
url	https://doaj.org/article/db48a90338b94bd7b02c1566ce8d177a
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Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention

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