Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A North American Perspective-2018 Update
Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A North American Perspective-2018 Update
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DOI：
10.1161/circulationaha.118.034722
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发表时间：
2018-07-31
期刊：
影响因子：
37.8
通讯作者：
Faxon, David P.
中科院分区：
文献类型：
--
作者：
Angiolillo, Dominick J.;Goodman, Shaun G.;Faxon, David P.
房颤患者经皮冠状动脉介入治疗支架植入术的最佳抗血栓治疗方案是临床实践中的一个挑战。2016年，报告了来自美国和加拿大的选定专家对接受经皮冠状动脉介入治疗的房颤患者治疗的最新意见。在2016年北美关于房颤患者接受经皮冠状动脉介入治疗的抗血栓治疗管理的共识声明之后，评估口服抗凝剂类型和抗血小板治疗持续时间的关键临床试验结果已经发表。基于这些结果，本报告重点更新了接受经皮冠状动脉介入治疗的房颤患者的抗血栓治疗，建议首选非维生素K拮抗剂口服抗凝剂而非维生素K拮抗剂作为口服抗凝剂。此外，对于大多数患者，应考虑在出院时接受双联治疗方案（口服抗凝剂+P2 Y（12）抑制剂单药抗血小板治疗），而对于选定的高缺血/血栓形成和低出血风险的患者，应考虑在有限的时间内延长阿司匹林的使用（即三联治疗）。本文件重点更新了新的专家共识建议的基本原理，该建议是关于接受经皮冠状动脉介入治疗并接受口服抗凝治疗的房颤患者的抗血栓管理。
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 P2Y(12) 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.