Farhan Serdar, Mehran Roxana
Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York City, New York, USA.
Coron Artery Dis. 2017 Dec;28(8):702-709. doi: 10.1097/MCA.0000000000000549.
The patient population with the need for oral anticoagulation to reduce stroke risk associated with atrial fibrillation (AF) and dual antiplatelet therapy to prevent stent thrombosis and myocardial infarction after percutaneous coronary intervention is increasing. However, patients treated with a triple therapy consisting of oral anticoagulation, aspirin, and a P2Y12 inhibitor have been demonstrated to be at high bleeding risk. The best combination of these agents and the duration of the different therapies are still uncertain. Recently, data on the safety of combinations including nonvitamin K antagonists have been published and evidence for the feasibility of a dual therapy is increasing. This review aims to provide insights to the pathophysiology of thrombus formation in AF versus coronary artery disease, summarize available data on postprocedural treatment strategies, and report current guidelines for AF patients after percutaneous coronary intervention. Furthermore, the role of stent type selection and tools to evaluate as well as strategies to reduce the individual bleeding risk will be discussed.
因心房颤动（AF）而需要口服抗凝药以降低中风风险，以及因经皮冠状动脉介入治疗后需要双重抗血小板治疗以预防支架内血栓形成和心肌梗死的患者群体正在增加。然而，接受口服抗凝药、阿司匹林和P2Y12抑制剂三联疗法治疗的患者已被证明出血风险很高。这些药物的最佳组合以及不同疗法的持续时间仍不确定。最近，关于包括非维生素K拮抗剂在内的联合用药安全性的数据已经发表，双重疗法可行性的证据也在增加。本综述旨在深入探讨AF与冠状动脉疾病中血栓形成的病理生理学，总结术后治疗策略的现有数据，并报告经皮冠状动脉介入治疗后AF患者的当前指南。此外，还将讨论支架类型选择的作用、评估工具以及降低个体出血风险的策略。
