Cardiology Department, Konstantopoulio General Hospital, Athens, Greece.
2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Thromb Res. 2019 Apr;176:133-139. doi: 10.1016/j.thromres.2019.02.022. Epub 2019 Feb 22.
Approximately 7% of patients undergoing percutaneous coronary intervention (PCI) with stent implantation have atrial fibrillation. The optimal antithrombotic treatment in such of patients remains one of the most challenging and difficult scenarios in Cardiology. Triple antithrombotic therapy (TAT), consisting of dual antiplatelet therapy plus an oral anticoagulant, has been used for decades in order to reduce ischemic and thromboembolic events, while significantly increasing the risk for severe bleeding. Recently, results of several clinical trials suggest that the use of dual antithrombotic therapy (DAT), consisting of single antiplatelet therapy plus an oral anticoagulant, reduces the risk of bleeding, while maintaining the same level of efficacy as compared to TAT. These data have been interpreted in a variety of ways, often giving conflicting recommendations and leaving many unanswered questions on the optimal antithrombotic treatments of patients with atrial fibrillation who undergo PCI. DAT consisting of a non-vitamin K antagonist oral anticoagulant and clopidogrel, while omitting aspirin from the immediate post discharge period, appears as an attractive, simplified strategy for most patients and supported by many experts in the field. In this review we aim to better define the role of DAT versus TAT in atrial fibrillation patients undergoing PCI and analyze remaining controversial issues and future expectations.
约 7%接受经皮冠状动脉介入治疗（PCI）和支架植入术的患者患有心房颤动。此类患者的最佳抗血栓治疗仍然是心脏病学中最具挑战性和困难的情况之一。三联抗血栓治疗（TAT），包括双联抗血小板治疗加口服抗凝剂，已使用数十年，以降低缺血和血栓栓塞事件的风险，同时显著增加严重出血的风险。最近，几项临床试验的结果表明，双联抗血栓治疗（DAT），包括单一抗血小板治疗加口服抗凝剂，可降低出血风险，同时保持与 TAT 相同的疗效。这些数据以多种方式进行了解释，经常给出相互矛盾的建议，并对接受 PCI 的心房颤动患者的最佳抗血栓治疗留下许多未解答的问题。DAT 由非维生素 K 拮抗剂口服抗凝剂和氯吡格雷组成，在出院后即刻期间不使用阿司匹林，对于大多数患者来说似乎是一种有吸引力的简化策略，并得到该领域许多专家的支持。在这篇综述中，我们旨在更好地定义 DAT 与 TAT 在接受 PCI 的心房颤动患者中的作用，并分析剩余的争议问题和未来的期望。
