Franchina Antonio Gabriele, Capodanno Davide
Divisione di Cardiologia, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Università degli Studi, Catania.
G Ital Cardiol (Rome). 2020 Feb;21(2 Suppl 1):26S-33S. doi: 10.1714/3311.32818.
In patients with atrial fibrillation (AF) who undergo an acute coronary syndrome (ACS), with or without percutaneous coronary intervention and coronary stent implantation, the association of dual antiplatelet therapy with an oral anticoagulant (also known as triple antithrombotic therapy, TAT) increases the risk for major and fatal bleeding. Recently, several trials have evaluated alternative therapeutic regimens to TAT, such as dual antithrombotic therapy (DAT) comprising a direct oral anticoagulant and a platelet P2Y12 receptor inhibitor. In the context of patients treated with percutaneous coronary intervention, these regimens have generally been associated with a reduction in bleeding that was not accompanied by a substantial increase in ischemic events. However, the net benefit of DAT is more controversial in the case of patients at higher thrombotic risk, such as patients with ACS. This review, based on the available literature, describes the best peri-procedural and post-procedural antithrombotic strategies for patients with AF and ACS.
在患有急性冠状动脉综合征（ACS）且伴有或不伴有经皮冠状动脉介入治疗及冠状动脉支架植入术的心房颤动（AF）患者中，双联抗血小板治疗与口服抗凝剂联合使用（也称为三联抗栓治疗，TAT）会增加严重出血和致命出血的风险。最近，多项试验评估了TAT的替代治疗方案，例如由直接口服抗凝剂和血小板P2Y12受体抑制剂组成的双联抗栓治疗（DAT）。在接受经皮冠状动脉介入治疗的患者中，这些方案通常与出血减少相关，且未伴有缺血事件的大幅增加。然而，对于血栓形成风险较高的患者，如ACS患者，DAT的净获益更具争议性。本综述基于现有文献，描述了AF合并ACS患者围手术期和术后最佳的抗栓策略。
