HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Table: Individual patient characteristics, treatment type, and duration Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (20) Citing Articles via Google Scholar Google Scholar Articles by Lip, G. Y. H. Articles by Karpha, M. Search for Related Content PubMed PubMed Citation Articles by Lip, G. Y. H. Articles by Karpha, M.

Anticoagulant and Antiplatelet Therapy Use in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention^*

The Need for Consensus and a Management Guideline

^* From the Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.

Correspondence to: Gregory Y. H. Lip, MD; City Hospital, Dudley Rd, Birmingham, B18 7QH, UK; e-mail: g.y.h.lip{at}bham.ac.uk

Abstract

Background: There is a lack of published evidence on what is the optimal management strategy in anticoagulated patients with nonvalvular atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) and, hence, need antiplatelet therapy.

Aims: Review of cases of patients with nonvalvular AF undergoing PCI in our hospital, either as an elective case or following acute coronary syndrome (ACS).

Methods: By means of our local West Midlands Regional Health Authority computerized Hospital Activity Analysis register, we obtained a list of all patients seen at our hospital with a diagnosis of AF in association with ACS or PCI between 2000 and 2005. Patient clinical details and antithrombotic therapy management during PCI were recorded.

Results: Of the drugs prescribed on discharge, aspirin and clopidogrel were prescribed to 25 patients (71.4%), while 6 patients (17.1%) were discharged receiving triple therapy, 2 patients (5.7%) receiving clopidogrel alone, and 2 patients (5.7%) receiving warfarin plus one antiplatelet drug (either aspirin or clopidogrel). There was wide variability in the antithrombotic regime and duration of treatment used by the four interventionists in our unit.

Conclusion: This case series reveals the lack of any coordinated strategy in the prevention of thrombotic or thromboembolic events in patients with AF and a recent PCI. Further large studies are required to assess the bleeding and thrombotic risk with various post-PCI strategies in order to facilitate the development of guidelines. Suggested management guidelines are made in this article.

Key Words: acute coronary syndrome • anticoagulation • antiplatelet • atrial fibrillation • percutaneous coronary intervention

This article has been cited by other articles:

				G. Y.H. Lip The Balance Between Stroke Prevention and Bleeding Risk in Atrial Fibrillation: A Delicate Balance Revisited Stroke, May 1, 2008; 39(5): 1406 - 1408. [Full Text] [PDF]

				T. Watson and G. Y.H. Lip Combining Antiplatelet Drugs and Oral Anticoagulant Therapy in Atrial Fibrillation: Acute Coronary Syndromes and/or Percutaneous Coronary Intervention/Stenting Revisited Stroke, October 1, 2007; 38(10): e107 - e108. [Full Text] [PDF]

				C.-W. Siu, M.-H. Jim, H.-H. Ho, R. Miu, S. W.L. Lee, C.-P. Lau, and H.-F. Tse Transient Atrial Fibrillation Complicating Acute Inferior Myocardial Infarction: Implications for Future Risk of Ischemic Stroke Chest, July 1, 2007; 132(1): 44 - 49. [Abstract] [Full Text] [PDF]

				D. A. Lane and G. Y. H. Lip Maintaining Therapeutic Anticoagulation: The Importance of Keeping "Within Range" Chest, May 1, 2007; 131(5): 1277 - 1279. [Full Text] [PDF]