Combined Antiplatelet and Anticoagulant Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Navigating Between Scylla and Charybdis
Authors: John U. Doherty
Journal: Annals of Internal Medicine (2020)

Editorials7 April 2020Combined Antiplatelet and Anticoagulant Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Navigating Between Scylla and CharybdisJohn U. Doherty, MDJohn U. Doherty, MDSidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (J.U.D.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-0572 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In The Odyssey, Ulysses navigates between 2 hazards, a rock shoal commandeered by a 6-headed monster (Scylla) and a whirlpool known for gobbling up ships and claiming their crews (Charybdis). The more he tries to avoid one hazard, the more vulnerable he becomes to the other. We face an analogous situation when caring for patients with atrial fibrillation (AF) after coronary stent placement who require anticoagulation to mitigate stroke risk and antiplatelet therapy to promote stent patency. We want to avoid bleeding events—which are increased with combination therapy—while also avoiding ischemic events, such as stent thrombosis, myocardial infarction, and ischemic ...References1. Hucker WJ, Kanzaria M, Doherty JU. Patients taking oral anticoagulants for atrial fibrillation with concomitant complex disease states. In: Flaker G, eds. Stroke Prevention in Atrial Fibrillation. St. Louis: Elsevier; 2019:149-59. Google Scholar2. Cannon CP, Bhatt DL, Oldgren J, et al; RE-DUAL PCI Steering Committee and Investigators. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017;377:1513-24. [PMID: 28844193] doi:10.1056/NEJMoa1708454 CrossrefMedlineGoogle Scholar3. Gibson CM, Mehran R, Bode C, et al. 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The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39:1330-93. [PMID: 29562325] doi:10.1093/eurheartj/ehy136 CrossrefMedlineGoogle Scholar10. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74:104-32. [PMID: 30703431] doi:10.1016/j.jacc.2019.01.011 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (J.U.D.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0572.Corresponding Author: John U. Doherty, MD, Jefferson Heart Institute, 925 Chestnut Street, Mezzanine, Philadelphia, PA 19107; e-mail, john.[email protected]edu.This article was published at Annals.org on 17 March 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDual Versus Triple Therapy for Atrial Fibrillation After Percutaneous Coronary Intervention Safi U. Khan , Mohammed Osman , Muhammad U. Khan , Muhammad Shahzeb Khan , Di Zhao , Mamas A. Mamas , Nazir Savji , Ahmad Al-Abdouh , Rani K. Hasan , and Erin D. Michos Metrics Cited byDual vs triple antiplatelet/anticoagulant therapy after PCI 7 April 2020Volume 172, Issue 7Page: 495-496KeywordsAntiplatelet therapyApixabanAspirinHemorrhageIschemic strokeMyocardial infarctionPercutaneous coronary interventionStent implantationStrokeThrombosis ePublished: 17 March 2020 Issue Published: 7 April 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...