DAPT plus anticoagulant therapy: The difficult coexistence post-ACS in older patients with atrial fibrillation

Abstract

Atrial fibrillation (AF) and coronary artery disease requiring percutaneous coronary intervention (PCI) and stenting often coexist in older patients. This poses the difficult problem of concurrent anticoagulant and double antiplatelet therapy (triple therapy). Current treatment guidelines do recommend triple therapy, especially in the course of acute coronary syndrome (ACS), with limitations due to an excessive risk of bleeding associated with this therapeutic regimen. This review summarizes randomized clinical trials and observational studies that compared triple therapy with a variety of different therapeutic options. Although the available evidence is not completely satisfactory and other studies are urgently needed, alternative regimens to triple therapy in AF patients undergoing PCI and stenting are promising, at least in terms of safety.

Keywords

• Dual anti-platelet therapy
• triple therapy
• acute coronary syndrome
• atrial fibrillation
• older patients
• hemorrhagic vs thromboembolic risk.