Abstract
The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non-vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y12 inhibitor) by the time of hospital discharge should be considered for most patients, whereas extending the use of aspirin beyond hospital discharge (ie, triple therapy) should be considered only for selected patients at high ischemic/ thrombotic and low bleeding risks and for a limited period of time. The present document provides a focused updated on the rationale for the new expert consensus-derived recommendations on the antithrombotic management of patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention.
Original language | English (US) |
---|---|
Pages (from-to) | 527-536 |
Number of pages | 10 |
Journal | Circulation |
Volume | 138 |
Issue number | 5 |
DOIs | |
State | Published - 2018 |
Keywords
- Anticoagulants
- Atrial fibrillation
- Platelet aggregation inhibitors
- Stents
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
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Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention : A North American perspective-2018 update. / Angiolillo, Dominick J.; Goodman, Shaun G.; Bhatt, Deepak L. et al.
In: Circulation, Vol. 138, No. 5, 2018, p. 527-536.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention
T2 - A North American perspective-2018 update
AU - Angiolillo, Dominick J.
AU - Goodman, Shaun G.
AU - Bhatt, Deepak L.
AU - Eikelboom, John W.
AU - Price, Matthew J.
AU - Moliterno, David J.
AU - Cannon, Christopher P.
AU - Tanguay, Jean Francois
AU - Granger, Christopher B.
AU - Mauri, Laura
AU - Holmes, David R.
AU - Gibson, C. Michael
AU - Faxon, David P.
N1 - Funding Information: Dr Angiolillo reports receiving payments as an individual for consulting fees or honoraria from Amgen, Aralez, AstraZeneca, Bayer, Biosensors, Bristol-Myers Squibb, Chiesi, Daiichi-Sankyo, Eli Lilly, Janssen, Merck, PLx Pharma, Pfizer, Sano-fi, and The Medicines Company, as well as for participation in review activities from CeloNova and St. Jude Medical. Dr Angiolillo reports institutional payments for grants from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi-Sankyo, Eisai, Eli-Lilly, Gilead, Janssen, Matsutani Chemical Industry Co, Merck, Novartis, Osprey Medical, and Renal Guard Solutions. In addition, Dr Angiolillo is the recipient of funding from the Scott R. MacKenzie Foundation and the National Institutes of Health/National Center for Advancing Translational Sciences Clinical and Translational Science Award UL1 TR000064 to the University of Florida and National Institutes of Health/National Human Genome Research Institute U01 HG007269. Dr Bhatt discloses the following relationships – Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic, Duke Clinical Re- Funding Information: search Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. Dr Cannon reports research grants from Amgen, Arisaph, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Janssen, Merck, and Takeda, as well as consulting fees from Alnylam, Amarin, Amgen, Arisaph, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Ei-sai, GlaxoSmithKline, Kowa, Lipimedix, Merck, Pfizer, Regeneron, Sanofi, and Takeda. Dr Eikelboom has received consulting fees and/or honoraria and grant support from AstraZeneca, Bayer Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, GlaxoSmithKline, Pfizer, Janssen, and Sanofi-Aventis. Dr Faxon discloses the following relationships: data safety and monitoring board: Boston Scientific Corp, Medtronic, Behring CLS, Biotronik, Direct Flow, Akebia, Jansen, Stentys, Orbus Neich, Harvard Clinical Research Institute, and Duke Clinical Research Institute; honorarium from the American Heart Association; and stock options in RIVA Medical. Dr Gibson discloses the following relationships: Bayer Corp, Janssen Pharmaceuticals, Johnson & Johnson Corp, Portola Pharmaceuticals, AstraZeneca, Eli Lilly, and The Medicines Company. Dr Goodman receives research grant support and/or speaker/consulting honoraria from Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, CSL Behring, Daiichi-Sankyo, Eli Lilly, Ferring Pharmaceuticals, Fenix Group International, Glax-oSmithKline, Janssen/Johnson & Johnson, Matrizyme, Luitpold Pharmaceuticals, Merck, Novartis, Pfizer, Regeneron, Sanofi, Servier, Tenax Therapeutics, Heart and Stroke Foundation of Ontario/University of Toronto, Canadian Heart Research Center and MD Primer, Canadian VIGOUR Center, and Duke Clinical Research Institute. Dr Granger reports the following: research grant support from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Meyers Squibb, GlaxoSmith-Kline, Medtronic Foundation, Daiichi Sankyo, Janssen Pharmaceuticals, Bayer, Pfizer, Novartis, Population Health Research Institute, US Food and Drug Administration, and National Heart, Lung, and Blood Institute, as well as consulting fees from Boehringer-Ingelheim, Bristol-Meyers Squibb, GlaxoSmithKline, Eli Lilly, Medtronic Foundation, Merck & Co, Novartis, Pfizer, Daiichi Sankyo, Rho Pharmaceuticals, Verseon, and Janssen Pharmaceuticals. Dr Holmes reports the following: both the Mayo Clinic and Dr Holmes have financial interest in technology related to this research. That technology has been licensed to Boston Scientific. Dr Mauri reports the following: grants to institution from Amgen, Abbott, Boston Scientific, Boehringer-Ingelheim, and Biotronik, as well as consulting fees from Amgen, Biotronik, Boehringer-Ingelheim, and Medtronic. Dr Moliterno reports being on the Data Safety Monitoring Board for Janssen Pharmaceuticals and having received research grant support from AstraZeneca. Dr Price reports consulting honoraria from AstraZeneca, Boston Scientific, Boehringer-Ingelheim, The Medicines Company, Celanova, Merck, ACIST Medical, Medtronic, St. Jude Medical, Terumo, and W.L. Gore & Associates, Inc, as well as speaking honoraria from Abbott Vascular, AstraZeneca, Boston Scientific, ACIST Medical, St. Jude Medical, and Terumo. Dr Tanguay reports the following relationships: consultant to Abbott Vascular, Actelion, AstraZeneca, Bayer, Biosensors, Eli Lilly, GE, Glaxo-SmithKline, Ikeria, Merck, Novartis, Servier, and Roche; research grants from Abbott Vascular, AstraZeneca, Biosensors, Boston Scientific, Novartis, Canadian Institute of Health Research, and National Institutes of Health; internal review committee for Canadian Institute of Health Research; and cochair of the Canadian Cardiovascular Society Antiplatelet Guidelines Committee. Publisher Copyright: © 2018 American Heart Association, Inc.
PY - 2018
Y1 - 2018
N2 - The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non-vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y12 inhibitor) by the time of hospital discharge should be considered for most patients, whereas extending the use of aspirin beyond hospital discharge (ie, triple therapy) should be considered only for selected patients at high ischemic/ thrombotic and low bleeding risks and for a limited period of time. The present document provides a focused updated on the rationale for the new expert consensus-derived recommendations on the antithrombotic management of patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention.
AB - The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non-vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y12 inhibitor) by the time of hospital discharge should be considered for most patients, whereas extending the use of aspirin beyond hospital discharge (ie, triple therapy) should be considered only for selected patients at high ischemic/ thrombotic and low bleeding risks and for a limited period of time. The present document provides a focused updated on the rationale for the new expert consensus-derived recommendations on the antithrombotic management of patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention.
KW - Anticoagulants
KW - Atrial fibrillation
KW - Platelet aggregation inhibitors
KW - Stents
UR - http://www.scopus.com/inward/record.url?scp=85050103367&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050103367&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.118.034722
DO - 10.1161/CIRCULATIONAHA.118.034722
M3 - Article
C2 - 30571525
AN - SCOPUS:85050103367
VL - 138
SP - 527
EP - 536
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 5
ER -