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Reviews in Cardiovascular Medicine  2021, Vol. 22 Issue (3): 659-675     DOI: 10.31083/j.rcm2203076
Special Issue: Contemporary Management of Special Subsets of Acute Coronary Syndromes Patients
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Management of antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes
Călin Pop1, 2, *, †(), Diana Țînț3, †, Antoniu Petris4, †
1Emergency Clinical County Hospital of Baia Mare, 430031 Baia Mare, Romania
2Faculty of Medicine Arad, "Vasile Goldis" University, 310025 Arad, Romania
3Faculty of Medicine, "Transilvania" University, B-dulEroilor 29, 500036 Brașov, Romania
4Cardiology Clinic, "St. Spiridon" County Emergency Hospital, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iaşi, Romania
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Abstract:
If atrial fibrillation (AF) and acute coronary syndrome (ACS) coexist, they should be treated with combined antithrombotic therapy. To reduce the risk of bleeding while maintaining the desired antithrombotic effect, choices should be made for each patient according to the balance between the bleeding and the thrombotic risk. There are many ways to select the type and dose of the oral anticoagulant (OAC) and P2Y12 inhibitors. As a rule of thumb, aspirin and P2Y12 inhibitors should be recommended to all patients. The duration of this combination therapy is a matter of debate; available data promote an initial period of one to four weeks of triple antithrombotic association with aspirin and P2Y12 inhibitors (clopidogrel in the absence of high ischaemic risk) and preferable direct oral anticoagulants (DOACs). On discontinuing aspirin, double therapy with P2Y12 inhibitors and a DOAC provides similar efficacy and superior safety for many patients on ACS medical or interventional treatment, especially if the risk of bleeding is high and that of thrombosis is low. Further studies are needed to clarify the concerns for a slight augmentation in the number of ischaemic cases (myocardial infarction and stent thrombosis) with double antithrombotic regimen in patients at high ischaemic risk.
Key words:  Atrial fibrillation      Acute coronary syndrome      Antithrombotic therapy      Percutaneous coronary intervention      Oral anticoagulants      Antiplatelets     
Submitted:  09 June 2021      Revised:  14 July 2021      Accepted:  22 July 2021      Published:  24 September 2021     
*Corresponding Author(s):  Călin Pop     E-mail:  medicbm@yahoo.com
About author:  These authors contributed equally.

Cite this article: 

Călin Pop, Diana Țînț, Antoniu Petris. Management of antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes. Reviews in Cardiovascular Medicine, 2021, 22(3): 659-675.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm2203076     OR     https://rcm.imrpress.com/EN/Y2021/V22/I3/659

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