Register
Forgot your password?

Review of modern concepts of triple and double antiplatelettherapy in patients with atrial fibrillationand coronary artery disease

Authors: Ruzina E.V., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

For correspondence:  Sign in or register.

Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2019-13-4-308-319

For citation: Ruzina E.V., Golukhova E.Z. Review of modern concepts of triple and double antiplatelet therapy in patients with atrial fibrillation and coronary artery disease. Creative Cardiology. 2019; 13 (4): 308–19 (in Russ.). DOI: 10.24022/1997-3187-2019-13-4-308-319

Received / Accepted:  02.12.2019/10.12.2019

Keywords: atrial fibrillation coronary heart disease vitamin K antagonists new oral anticoagulants antiplatelet therapy

Full text:  

 

Abstract

Atrial fibrillation (AF) is the most common heart rhythm disorder in the general population. 5–10% of patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease have concomitant AF, and, as a result, the need for oral anticoagulants (OAC) in addition to antiplatelet therapy. Over the past few years, with atrial fibrillation, as a well-known anticoagulant – a vitamin K antagonist (warfarin), new OAC (rivaroxaban, dabigatran, apixaban) has been increasingly used, which have successfully passed all clinical trials, are convenient in use and not only require INR control, but also any other indicators of the coagulogram. However, the use of new OAC in conjunction with antiplatelet drugs raises many questions and concerns about an increase in the frequency of hemorrhagic complications. The article provides an overview of modern studies from 2012 to the present, aimed at studying various combinations and the duration of taking antiplatelet and anticoagulant drugs. To date, the appointment of double and triple antithrombotic therapy in patients after acute coronary syndrome / PCI and AF continues to remain open, given the high risks of relapse of embolic events and, especially, bleeding.

References

  1. Lip G.Y., Laroche C., Popescu M.I., Rasmussen L.H., Vitali-Serdoz L., Dan G.A. et al. Improved outcomes with European Society of Cardiology guideline-adherent antithrombotic treatment in high-risk patients with atrial fibrillation: a report from the EORP-AF General Pilot Registry. Europace. 2015; 17: 1777–86. DOI: 10.1093/europace/euv269
  2. Kirchhof P., Ammentorp B., Darius H., Darius H., De Caterina R., Le Heuzey J.-Y. et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events – European Registry in Atrial Fibrillation (PREFER in AF). Europace. 2014; 16: 6–14. DOI: 10.1093/europace/eut263
  3. January C.T., Wann L.S., Alpert J.S., Calkins H., Cigarroa J.E., Cleveland J.C. et al. 2014 AHA/ ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014: 130; 2071–104. DOI: 10.1016/j.jacc.2014.03.021
  4. Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 2016; 37: 2893–962. DOI: 10.1093/eurheartj/ehw210
  5. Wiviott S.D., Braunwald E., Angiolillo D.J., Meisel S., Dalby A.J., Verheugt F.W. et al. Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel – thrombolysis in myocardial infarction. Circulation. 2008; 118: 1626–36. DOI: 10.1161/CIRCULATIONAHA.108.791061
  6. Gurwitz J.H., Goldberg R.J. Age-based exclusions from cardiovascular clinical trials: implications for elderly individuals (and for all of us): comment on 'the persistent exclusion of older patients from ongoing clinical trials regarding heart failure'. Arch. Intern. Med. 2011; 171: 557–8. DOI: 10.1001/archinternmed.2011.33
  7. Kakkar A.K., Mueller I., Bassand J.P., Fitzmaurice D.A., Goldhaber S.Z., Goto S. et al. International longitudinal registry of patients with atrial fibrillation at risk of stroke: Global Anticoagulant Registry in the FIELD (GARFIELD). AHJ. 2012; 163 (1): 13–9. DOI: 10.1016/j.ahj.2011.09.011
  8. Napalkov D.A., Sokolova A.A., Rodionov A.V. Atrial fibrillation and ischemic heart disease: how to combine antiplatelet and anticoagulant therapy, depending on the clinical situation? Rational Pharmacotherapy in Cardiology. 2016; 12 (2): 191–5 (in Russ.). DOI: 10.20996/1819-6446-2016-12-2-191-195
  9. Dewilde W.J.M., Oirbans T., Verheugt F.W.A., Kelder J.C., De Smet B.J., Herrman J.P. et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open- label, randomised, controlled trial. Lancet. 2013; 381: 1107–15. DOI: 10.1016/S0140-6736(12)62177-1
  10. Chaturvedula S., Diver D., Vashist A. Antiplatelet therapy in coronary artery disease: a daunting dilemma. J. Clin. Med. 2018; 7 (4): 74. DOI: doi.org/10.3390/jcm7040074
  11. Eikelboom J.W., Mehta S.R., Anand S.S., Changchun Xie, Keith A.A., Yusuf S. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006; 114: 774–82. DOI: 10.1161/CIRCULATIONAHA.106.612812
  12. Doyle B.J., Rihal Ch.S., Gastineau D.A., Holmes D.R. Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice. J. Am. Coll. Cardiol. 2009; 53: 2019–27. DOI: 10.1016/j.jacc.2008.12.073
  13. Fox K.A.A. Dual or single antiplatelet therapy with anticoagulation? Lancet. 2013; 381 (9872): 1080–1. DOI: 10.1016/S0140-6736(13)60054-9
  14. Gibson C.M., Mehran R., Bode C., Halperin J., Verheugt F.W., Wildgoose P. et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N. Engl. J. Med. 2016; 375: 2423–34. DOI: 10.1056/NEJMoa1611594
  15. Cannon C.P., Bhatt D.L., Oldgren J., Lip G.Y.H., Ellis S.G., Kimura T. et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N. Engl. J. Med. 2017; 377: 1513–24. DOI: 10.1056/NEJMoa1708454
  16. Connolly S.J., Ezekowitz M,D., Yusuf S., Eikelboom J., Oldgren J., Parekh A. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2009; 361: 1139-51. DOI: 10.1517/14656560903530691
  17. Lopes R.D., Heizer G., Aronson R., Vora A.N., Massaro T., Mehran R. et al. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. New Engl. J. Med. 2019; 380 (16): 1509–24. DOI: 10.1056/NEJMoa1817083
  18. Roffi M., Patrono C., Collet J.P., Mueller C., Valgimigli M., Andreottiet F. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2016; 37: 267–315. DOI: 10.1093/eurheartj/ehv320
  19. Golukhova E.Z., Bulaeva N.I. Atrial fibrillation in 2014: based on the updated guidelines AHA/ACC/HRS. Creative Cardiology. 2014; 3: 5–13 (in Russ.)
  20. ACC/AHA Task Force members, January C.T., Wann L.S., Alpert J.S., Calkins H., Cigarroa J.E., Cleveland J.C. Jr. et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014; 130: e199–267. DOI: 10.1016/j.jacc.2014.03.021
  21. Hijazi Z., Oldgren J., Lindback J., Alexander J.H., Connolly S.J., Eikelboom J.W. et al. The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study. Lancet. 2016; 387: 2302–11. DOI: 10.1016/S0140-6736(16)00741-8
  22. Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B. et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. J. Cardiothorac. Surg. 2016; 50 (5): e1–e88. DOI: 10.1093/ejcts/ezw313
  23. Valgimigli M., Bueno H., Byrne R.A., Collet J.P., Costa F., Jeppsson A. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur. J. Cardiothorac. Surg. 2018; 53 (1): 34–78. DOI: 10.1093/ejcts/ezx334
  24. Vranckx P., Lewalter T., Valgimigli M., Tijssen J.G., Reimitz P.E., Eckardtet L. et al. Evaluation of the safety and efficacy of an edoxabanbased antithrombotic regimen in patients with atrial fibrillation following successful percutaneous coronary intervention (PCI) with stent placement: rationale and design of the ENTRUST-AF PCI trial. Am. Heart J. 2018; 196: 105–12. DOI: 10.1016/j.ahj.2017.10.009
  25. Gao F., Shen H., Wang Z.J., Yang S.W., Liu X.L., Zhou Y.J. Rationale and design of the RT-AF study: combination of rivaroxaban and ticagrelor in patients with atrial fibrillation and coronary artery disease undergoing percutaneous coronary intervention. Contemp. Clin. Trials. 2015; 43: 129–32. DOI: 10.1016/j.cct.2015.05.012

About Authors

  • Evgeniya V. Ruzina, Postgraduate, Cardiologist, ORCID
  • Elena Z. Golukhova, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences, Head of Department, Acting Director, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by