Castiello Domenico Simone, Buongiorno Federica, Manzi Lina, Narciso Viviana, Forzano Imma, Florimonte Domenico, Sperandeo Luca, Canonico Mario Enrico, Avvedimento Marisa, Paolillo Roberta, Spinelli Alessandra, Cristiano Stefano, Simonetti Fiorenzo, Semplice Federica, D'Alconzo Dario, Vallone Donato Maria, Giugliano Giuseppe, Sciahbasi Alessandro, Cirillo Plinio, Gragnano Felice, Calabrò Paolo, Esposito Giovanni, Gargiulo Giuseppe
Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy.
Interventional Cardiology, Sandro Pertini Hospital, 00157 Rome, Italy.
J Cardiovasc Dev Dis. 2025 Apr 8;12(4):142. doi: 10.3390/jcdd12040142.
In the past decades, percutaneous coronary intervention (PCI) has become the most common modality for myocardial revascularization in patients with coronary artery disease (CAD). Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is essential in all patients undergoing PCI to prevent thrombotic complications. A large proportion of patients undergoing PCI also have concomitant atrial fibrillation (AF), thus requiring an oral anticoagulant (OAC) to prevent ischemic stroke or systemic embolism. However, the association between OAC and DAPT further increases the risk of bleeding. Compared with a triple antithrombotic therapy (TAT), dual antithrombotic therapy (DAT) has shown to reduce bleeding events, but at the cost of higher risk of stent thrombosis. In this field, patients with AF undergoing PCI represent a special population with significant challenges, and several strategies are needed to reduce the risk for bleeding complications. In this review, we will discuss both the procedural and antithrombotic strategies to optimize ischemic and bleeding outcomes in patients with AF undergoing PCI.
在过去几十年中，经皮冠状动脉介入治疗（PCI）已成为冠心病（CAD）患者心肌血运重建最常用的方式。对所有接受PCI的患者而言，阿司匹林联合P2Y12抑制剂的双联抗血小板治疗（DAPT）对于预防血栓形成并发症至关重要。很大一部分接受PCI的患者同时合并心房颤动（AF），因此需要口服抗凝药（OAC）来预防缺血性卒中或全身性栓塞。然而，OAC与DAPT联合使用会进一步增加出血风险。与三联抗栓治疗（TAT）相比，双联抗栓治疗（DAT）已显示可减少出血事件，但代价是支架血栓形成风险更高。在这一领域，接受PCI的AF患者是面临重大挑战的特殊人群，需要多种策略来降低出血并发症风险。在本综述中，我们将讨论优化接受PCI的AF患者缺血和出血结局的手术及抗栓策略。
