See also Coronary Stent Thrombosis.
Background
We know that: 1. These patients need some sort of protection for stroke risk (from AF), and from in-stent thrombosis (from PCI). 2. Triple therapy (ASA + P2Y12 + OAC) is effective, but increases bleeding risk.
Therefore, what is the optimal strategy after PCI (elective or for ACS) in patients with AF requiring anticoagulation for their AF (high stroke risk, CHADS2 > 0)?
Historical Trials
2013 - WOEST trial as above. VKA + clopidogrel vs triple therapy. Reduced bleeding but underpowered for thrombosis differences. 2015 - ISAR-TRIPLE trial showing triple therapy with 6 weeks of clopidogrel was noninferior to 6 months of clopidogrel (+ASA/VKA)
New Trials Examining Dual-Pathway Antithrombotics for PCI + AF
| Trial | Drug / Intervention | Notes |
|---|---|---|
| PIONEER-AF (2016) | Rivaroxaban | |
| RE-DUAL (2017) | Dabigatran | |
| AUGUSTUS (2019) | Apixaban | |
| ENTRUST-AF PCI (2019) | Edoxaban |
Summary
2018 CCS Guidelines:
