Antıthrombotıc Therapy in Patıents wıth AF and ACS

Up to 30% of patients with atrial fibrillation(AF) enrolled in the 4 major trials of NOACs(New oral anticoagulants) have history of concomitant coronary artery disease with nearly 15% of them had prior MI.

In unselected AF registry patients 15% of them had prior MI.Nearly 6-8% of thepatients undergoing PCI have long term OAC indication.

So patients with AF and an ACS(or stable CHD) may require PCI with stenting.In that situation they need OAC treatment to prevent stroke and DAPT(Dual antiplatelet therapy)to prevent stent thrombosis.This should be balanced against the increased risk of bleeding with dua lor triple antithrombotic therapy.

Data from all trials done so far and the guidelines recommend the duration of dual or triple therapy after PCI in patients with AF by concensus (Level C).

At present it can be summarised as shown below: