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Percutaneous coronary intervention and atrial fibrillation: the triple therapy dilemma

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Abstract

Atrial fibrillation (AF) represents the most common cardiac arrhythmia and chronic oral anticoagulation (OAC) is the cornerstone therapy to prevent cerebrovascular events among those having high thromboembolic risk. However, 20-30% of patients with AF have co-existing coronary artery disease (CAD). Importantly, since the prevalence of both AF and CAD increase with age, management of these patients has become an emerging clinical problem with the ever growing elderly population. In particular, many of these patients may develop an acute coronary syndrome (ACS) or require percutaneous coronary intervention (PCI), leading to the concomitant use of dual antiplatelet therapy (DAPT) including aspirin and a P2Y12 receptor inhibitor in addition to OAC, also known as triple antithrombotic therapy (TAT). However, TAT comes at the expense of an increased risk of bleeding complications. This viewpoint focuses on the current evidence of treatment, areas of unmet needs and future perspectives in the management of these high-risk patients.

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Conflict of interest

Dominick J. Angiolillo received payment as an individual for: (a) Consulting fee or honorarium from Bristol Myers Squibb, Sanofi-Aventis, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Merck, Evolva, Abbott Vascular, Bayer and PLx Pharma; (b) Participation in review activities from CeloNova, Johnson & Johnson, St. Jude, and Sunovion. Institutional payments for grants from Bristol Myers Squibb, Sanofi-Aventis, Glaxo Smith Kline, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Evolva, and Gilead. All other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

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  1. University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Jung Rae Cho & Dominick J. Angiolillo

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  1. Jung Rae Cho
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Correspondence to Dominick J. Angiolillo.

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Cho, J.R., Angiolillo, D.J. Percutaneous coronary intervention and atrial fibrillation: the triple therapy dilemma. J Thromb Thrombolysis 39, 203–208 (2015). https://doi.org/10.1007/s11239-014-1132-z

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