Abdulrahman Balen, Jabbour Richard J, Curzen Nick
Coronary Research Group, University Hospital Southampton NHS Foundation Trust Southampton, UK.
Faculty of Medicine, University of Southampton Southampton, UK.
Interv Cardiol. 2023 Jun 13;18:e22. doi: 10.15420/icr.2022.40. eCollection 2023.
The prevalence of AF in patients with coronary artery disease is high. The guidelines from many professional groups, including the European Society of Cardiology, American College of Cardiology/American Heart Association and Heart Rhythm Society, recommend a maximum duration of 12 months of combination single antiplatelet and anticoagulation therapy in patients who undergo percutaneous coronary intervention and who have concurrent AF, followed by anticoagulation alone beyond 1 year. However, the evidence that anticoagulation alone without antiplatelet therapy adequately reduces the well-documented attritional risk of stent thrombosis after coronary stent implantation is relatively sparse, particularly given that very late stent thrombosis (>1 year from stent implantation) is the commonest type. By contrast, the elevated risk of bleeding from combined anticoagulation and antiplatelet therapy is clinically important. The aim of this review is to assess the evidence for long-term anticoagulation alone without antiplatelet therapy 1 year post-percutaneous coronary intervention in patients with AF.
冠心病患者中房颤的患病率很高。包括欧洲心脏病学会、美国心脏病学会/美国心脏协会和心律学会在内的许多专业组织的指南建议，接受经皮冠状动脉介入治疗且并发房颤的患者，联合单一抗血小板和抗凝治疗的最长持续时间为12个月，1年后仅进行抗凝治疗。然而，没有抗血小板治疗的单纯抗凝治疗能充分降低冠状动脉支架植入术后已被充分证明的支架内血栓形成的持续性风险的证据相对较少，特别是考虑到极晚期支架内血栓形成（支架植入后>1年）是最常见的类型。相比之下，联合抗凝和抗血小板治疗导致出血风险升高在临床上具有重要意义。本综述的目的是评估房颤患者经皮冠状动脉介入治疗1年后不进行抗血小板治疗而单纯进行长期抗凝治疗的证据。
