Περίληψη:
Patients with atrial fibrillation (AF) undergoing percutaneous coronary
intervention (PCI) have traditionally received triple antithrombotic
therapy (TAT) consisting of aspirin and a P2Y(12)inhibitor plus an oral
anticoagulant (OAC) to reduce atherothrombotic events, even though this
strategy is associated with a high risk of severe bleeding. Recent
trials have indicated that dual antithrombotic therapy (DAT), consisting
of a P2Y(12)inhibitor plus an OAC, may be superior to TAT in terms of
bleeding risk; however, the trade-off regarding ischemic complications
may be questionable. Patients who have had a myocardial infarction (MI)
before undergoing PCI warrant special consideration because of the
accompanying high ischemic risk, including stent thrombosis, which might
be exacerbated by an aspirin-free strategy such as DAT. In particular,
in the acute phase of ST-segment elevation MI (STEMI), the highly
prothrombotic milieu may necessitate initial TAT, though durations may
vary, making a tailored antithrombotic regimen for this high-risk subset
of patients a fairly challenging and difficult scenario for clinicians.
Since patients with MI, especially STEMI, are underrepresented in
randomized trials, data regarding the optimal antithrombotic treatment
in such patients are sparse. This review aims to analyze the outcomes of
different antithrombotic regimens in patients with MI and AF undergoing
PCI, define the role of DAT versus TAT regarding safety and efficacy
outcomes, and address controversial issues and future perspectives.
Συγγραφείς:
Benetou, Despoina-Rafailia
Varlamos, Charalampos
Mpahara,
Aikaterini
Alexopoulos, Dimitrios
