Di Bari Mauro, Pratesi Alessandra, Nigro Francesca M, Marozzi Irene, Fumagalli Stefano
University of Florence, Department of Experimental and Clinical Medicine.
Monaldi Arch Chest Dis. 2018 Jun 7;88(2):957. doi: 10.4081/monaldi.2018.957.
Atrial fibrillation (AF) and coronary artery disease requiring percutaneous coronary intervention (PCI) and stenting often coexist in older patients. This poses the difficult problem of concurrent anticoagulant and double antiplatelet therapy (triple therapy). Current treatment guidelines do recommend triple therapy, especially in the course of acute coronary syndrome (ACS), with limitations due to an excessive risk of bleeding associated with this therapeutic regimen. This review summarizes randomized clinical trials and observational studies that compared triple therapy with a variety of different therapeutic options. Although the available evidence is not completely satisfactory and other studies are urgently needed, alternative regimens to triple therapy in AF patients undergoing PCI and stenting are promising, at least in terms of safety.
心房颤动（AF）与需要经皮冠状动脉介入治疗（PCI）和置入支架的冠状动脉疾病在老年患者中常常并存。这就带来了抗凝和双联抗血小板治疗（三联疗法）同时进行的难题。当前的治疗指南确实推荐三联疗法，尤其是在急性冠状动脉综合征（ACS）病程中，但由于这种治疗方案存在出血风险过高的局限性。本综述总结了将三联疗法与各种不同治疗选择进行比较的随机临床试验和观察性研究。尽管现有证据并不完全令人满意且迫切需要其他研究，但对于接受PCI和置入支架的房颤患者而言，三联疗法的替代方案至少在安全性方面是有前景的。
