disease interaction(s) of atrial fibrillation with coronary artery disease
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Management
- patients with atrial fibrillation & coronary artery disease often need dual anticoagulation & anti-platelet therapy[1]
- the combination of direct oral anticoagulant + P2Y12 inhibitor is as effective as anticoagulant + P2Y12 inhibitor + aspirin in preventing myocardial ischemia with less bleeding[1][2][3]
- in patients with atrial fibrillation & stable coronary artery disease, edoxaban monotherapy results in lower risk of composite all-cause mortality, myocardial infarction, stroke, systemic embolism, urgent revascularization, or major bleeding than dual antithrombotic therapy (anti-platelet therapy plus anticoagulation)[4]
- in patients with atrial fibrillation & stable coronary artery disease oral anticoagulant monotherapy is associated with less bleeding than oral anticoagulant plus single antiplatelet agent without a difference in ischemic events[5]
- in patients with chronic coronary syndrome at high atherothrombotic risk receiving an oral anticoagulant, addition of aspirin led to a higher risk of
- cardiovascular death
- myocardial infarction
- stroke, systemic embolism
- coronary revascularization
- acute limb ischemia
- major bleeding
- death from any cause[6]
More general terms
References
- ↑ 1.0 1.1 1.2 Lamberts M et al. Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention. J Am Coll Cardiol 2013 Sep 10; 62:981 PMID: https://pubmed.ncbi.nlm.nih.gov/23747760
Markowitz SM. Antithrombotic regimens in patients with atrial fibrillation and coronary disease: Optimizing efficacy and safety. J Am Coll Cardiol 2013 Sep 10; 62:990. PMID: https://pubmed.ncbi.nlm.nih.gov/23747772 - ↑ 2.0 2.1 Link MS Which Anticoagulation Strategy for Patients with Atrial Fibrillation and a New Stent? NEJM Journal Watch. Nov 14, 2016 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Gibson CM, Mehran R, Bode C et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016 Nov 14 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/27959713 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1611594 - ↑ 3.0 3.1 Cannon CP, Bhatt DL, Oldgren J, et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med 2017; 377:1513-1524. October 19, 2017 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/28844193 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1708454
- ↑ 4.0 4.1 4.2 4.3 Cho MS, Kang DY, Ahn JM et al Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease. N Engl J Med. 2024 Sep 1. PMID: https://pubmed.ncbi.nlm.nih.gov/39225258 https://www.nejm.org/doi/full/10.1056/NEJMoa2407362
Lip GYH. Atrial fibrillation and stable coronary artery disease. N Engl J Med 2024 Sep 1; PMID: https://pubmed.ncbi.nlm.nih.gov/39225269 https://www.nejm.org/doi/10.1056/NEJMe2409696 - ↑ 5.0 5.1 5.2 5.3 Rashedi S, Keykhaei M, Sato A, et al. Anticoagulation and Antiplatelet Therapy for Atrial Fibrillation and Stable Coronary Disease: Meta-Analysis of Randomized Trials. J Am Coll Cardiol. 2025 Jan 17:S0735-1097(25)00071-3. PMID: https://pubmed.ncbi.nlm.nih.gov/39918465 https://www.sciencedirect.com/science/article/abs/pii/S0735109725000713
- ↑ 6.0 6.1 6.2 6.3 Lemesle G, Didier R, Steg PG et al. for the AQUATIC Trial Investigators. Aspirin in patients with chronic coronary syndrome receiving oral anticoagulation. N Engl J Med 2025 Aug 31; PMID: https://pubmed.ncbi.nlm.nih.gov/40888725 https://www.nejm.org/doi/10.1056/NEJMoa2507532