Antithrombotic therapy in atrial fibrillation and stent implantation: Treatment or threats by the use of triple or dual antithrombotic therapy

摘要

Atrial fibrillation (AF) is associated with increased risk of stroke and thromboembolism, and thus oral anticoagulation (OAC) therapy is indicated in patients considered at moderate-to-high risk. The net clinical benefit favors anticoagulation for almost all AF patients with the exception of those at very low risk of ischaemic stroke, with a CHA_2DS_2-VASc score of 0 (1, 2). When the CHA_2DS_2-VASc score is applied to many AF populations, the percentage of patients with an indication for OAC is increased, as high as 94% (3-5). Based on the results of a real-world nationwide cohort study of patients with non-valvular AF, the net clinical benefit was clearly in favor of VKA treatment in AF patients with increased risk of stroke/thromboembolism, regardless of bleeding risk estimation (as assessed by the HAS-BLED risk score) (1, 2,6).