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Warfarin or new anticoagulants in atrial fibrillation patients undergoing PCI

ESC Congress Report

  • Data currently limited, but several trials ongoing.
  • Third generation stents permit short DAPT duration.
  • Treatment decisions required to assess stroke and bleeding risk.


View the Slides from this session in ESC Congress 365

This session, chaired by myself and Stephan Windecker (Switzerland) deals with a complex management patient group – how to manage patients with atrial fibrillation presenting with an acute coronary syndrome (ACS) and/or undergoing percutaneous coronary intervention and/or stenting?  This session follows the recent publication of the 2014 European joint consensus document, from the ESC Working Group on Thrombosis, EHRA, EAPCI and ACCA, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society [1].

J M. Ten Berg (Nieuwegein, NL) provided an overview of challenges and evidence, setting the scene for the new joint consensus document.  He reviewed the new evidence for concomitant oral anticoagulation plus antiplatelet therapy use from observational studies, the one randomized trial (WOEST) and the data from the non-Vitamin K Oral anticoagulants (NOACs, previously referred to as new or novel oral anticoagulants.  Ongoing randomized trials (PIONEER-AF, RE-DUAL PCI, etc) will provide additional data.

K. Huber (Vienna, AT) provided an overview on managing coronary stenting.  He discussed new data with 3rd generation drug eluting stents (described in the new European consensus document) and how with their smaller strut size and improved stent technology, we are moving towards shorter duration antiplatelet therapy.
 

D. Capodanno (Catania, IT) provided an overview of antithrombotic strategies in relation  to managing  TAVI, and reviewed the evidence on what's best to use in this complex group of patients.  

P. Kirchhof (Birmingham, GB) provided a summary of the recommendations from the joint consensus document. In general this decision is still dependent upon stroke and bleeding risk assessment, clinical setting (acute vs elective, etc), etc. In general there is the need for triple therapy, followed by dual therapy (OAC plus clopidogrel) and then beyond 12 months, OAC alone.

In summary, this session provides an important insight into the new 2014 European consensus document, which deals with the optimal manner to optimally manage this important patient group, which requires balancing stroke prevention against stent thrombosis or recurrent ischaemia ischaemia, and bleeding risks.
   

References


1.  Lip GY, Windecker S, Huber K, Kirchhof P, Marin F, Ten Berg JM, Haeusler KG, Boriani G, Capodanno D, Gilard M, Zeymer U, Lane D; Document Reviewers, Storey RF, Bueno H, Collet JP, Fauchier L, Halvorsen S, Lettino M, Morais J, Mueller C, Potpara TS, Rasmussen LH, Rubboli A, Tamargo J, Valgimigli M, Zamorano JL. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J. 2014 Aug 25. pii: ehu298. [Epub ahead of print]

SessionNumber:

190

SessionTitle:

Warfarin or new anticoagulants in atrial fibrillation patients undergoing PCI

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.