Brigham and Women's Hospital, Boston, Massachusetts.
Clin Cardiol. 2013 Oct;36(10):585-94. doi: 10.1002/clc.22167. Epub 2013 Jul 19.
Patients with atrial fibrillation affected by an acute coronary syndrome have indications for oral anticoagulation and dual antiplatelet therapy with aspirin and a P2Y12 adenosine diphosphate receptor inhibitor after coronary artery stenting. The concurrent use of all 3 agents, termed triple oral antithrombotic therapy, significantly increases the risk of bleeding. To date, there is a lack of evidence on the proper combination and duration of anticoagulant and antiplatelet agents in patients with indications for both therapies. As such, care has been guided by expert opinion, and there is wide variation in clinician practice. In this review, the latest evidence on the risks and benefits of triple oral antithrombotic therapy in patients with atrial fibrillation after coronary artery stenting is summarized. We discuss the clinical risk scores useful in guiding the prediction of stroke, bleeding, and stent thrombosis. Additionally, we highlight where additional evidence is needed to determine the proper balance of anticoagulant and antiplatelet agents in this patient population.
患有急性冠状动脉综合征的心房颤动患者，在冠状动脉支架置入术后有口服抗凝和双重抗血小板治疗（阿司匹林和 P2Y12 二磷酸腺苷受体抑制剂）的指征。同时使用这 3 种药物（称为三联口服抗血栓治疗）会显著增加出血风险。迄今为止，对于同时存在这两种治疗指征的患者，抗凝和抗血小板药物的适当联合和持续时间尚缺乏证据。因此，临床医生根据专家意见进行治疗，临床实践存在很大差异。在这篇综述中，总结了在冠状动脉支架置入术后患有心房颤动的患者中三联口服抗血栓治疗的风险和获益的最新证据。我们讨论了有助于预测中风、出血和支架血栓形成的临床风险评分。此外，我们还强调了在确定该患者人群中抗凝和抗血小板药物的适当平衡方面需要哪些额外证据。
