Approaches to anticoagulation therapy selection in patients with non-valvular atrial fibrillation and ischemic heart disease

Abstract

In the article, approaches presented to antithrombotic therapy (AT) in patients with non-valvular atrial fibrillation (AF) and coronary heart disease (CHD), in acute coronary syndrome (ACS), as in stable forms, incl. those underwent percutaneous coronary intervention. Regimens selection and duration of AT depend on the type of CHD, bleeding risks, anatomy of implanted stents in coronary arteries. As AT, in recent guidelines, for patients with AF and CHD any oral anticoagulant is recommended: vitamin K antagonists, direct thrombin inhibitor dabigatran, selective Xa factor inhibitors rivaroxaban, apixaban. Largest evidence among the novel oral anticoagulants is available for dabigatran. Choice from double or triple AT regimens for CHD patients with AF is under discussion. Among antiplatelet drugs for combination with anticoagulant, clopidogrel is preferred, as safer comparing to aspirin. Possibility to use combination therapy with anticoagulants, of ticagrelor and prasugrel is restricted. It is also pointed on the necessity of proton pump inhibitors usage during double or triple AT for patients with non-valvular fibrillation and CHD.

Keywords

• non-valvular atrial fibrillation
• ischemic heart disease
• anticoagulants
• antiplatelet therapy