THE SPECIFICS OF PRESCRIBING TRIPLE ANTITROMBOTIC THERAPY WITH RIVAROXABAN IN PATIENTS WITH ATRIAL FIBRILLATION AFTER CORONARY ARTERY STENTING
https://doi.org/10.21518/2307-1109-2017-1-114-121
Abstract
A trial fibrillation occurs in 5 to 8% of patients who underwent percutaneous coronary intervention (PCI) with stenting. It is known that dual antiplatelet therapy (a combination of P2Y12 receptor inhibitor and acetylsalicylic acid) significantly reduces the risk of developing stent thrombosis in comparison with vitamin K antagonists; however, anticoagulants are significantly more effective in reducing the risk of ischemic stroke in patients with atrial fibrillation (AF). When opting for a long-term triple antithrombotic therapy, the risk of hemorrhagic complications increases dramatically, while choosing less intensive treatment results in an increased risk of ischemic complications, primarily, ischemic stroke and stent thrombosis. The current recommendations come down to the prescription of all of the three components of antithrombotic therapy. However, this approach leads to a significant increase in the frequency of hemorrhagic complications. The purpose of recent randomized trials was to compare and evaluate the efficacy and safety of different regimens with antithrombotic drugs in combination with rivaroxaban in patients with AF who underwent PCI.
About the Authors
N. A. Novikova
First Moscow State Medical University named after I.M. Sechenov
Russian Federation
Prof.
Russian Federation
Prof.
A. S. Shilova
First Moscow State Medical University named after I.M. Sechenov
Russian Federation
Russian Federation
References
1. Rubboli A, Colletta M, Herzfeld J, Sangiorgio P, Di Pasquale G. Periprocedural and medium term antithrombotic strategies in patients with an indication for long-term anticoagulation undergoing coronary angiography and intervention. Coron Artery Dis, 2007, 18: 193-9.
2. Husted S, De Caterina R, Andreott Huber Storey WeitzJI Esc Working Group On Thrombosis Task Force On Anticoagulants In Heart Disease OBNon-vitamin K antagonist oral anticoagulants (NOACs): no longer new or novel. Thromb Haemost, 2014, 111: 781-782.
3. Wang TY, Robinson LA, Ou FS, et al. Discharge antithrombotic strategies among patients with acute coronary syndrome previously on warfarin anticoagulation: physician practice in the CRUSADE registry. Am Heart J, 2008, 155: 361-8.
4. ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomized controlled trial. Lancet, 2006, 367: 1903-12.
5. Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace, 2010, 12: 1360-420.
6. Popma CJ, Sheng S, Korjian S, et al. Lack of concordance between local investigators, angiographic core laboratory, and clinical event committee in the assessment of stent thrombosis: results from the TRACER angiographic substudy. Circ Cardiovasc Interv, 2016, 9(5): e003114.
7. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med, 2011, 365: 883-91.
8. Mega JL, Braunwald E, Mohanavelu S, et al. Rivaroxaban versus placebo in patients with acute coronary syndromes (ATLAS ACS-TIMI 46): a randomised, double-blind, phase II trial. Lancet, 2009, 374: 29-38.
9. Mega JL, Braunwald E, Wiviott SD, et al. Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med, 2012, 366: 9-19.
10. Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet, 2013, 381: 1107-15.
11. Gibson CM, Mehran R, Bode C, et al. An open-label, ran-domized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a doseadjusted oral vitamin K antagonist treatmentstrategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI). Am Heart J, 2015, 169(4): 472-8.e5.
12. Popma CJ, Sheng S, Korjian S, et al. Lack of concordance between local investigators, angiographic core laboratory, and clinical event committee in the assessment of stent thrombosis: results from the TRACER angiographic substudy. Circ Cardiovasc Interv, 2016, 9(5): e003114.
13. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal doi:10.1093/eurheartj/ehw210
14. Stroke Prevention in Atrial Fibrillation Study Investigators. Final results. Circulation, 1991, 84(2): 527-539.
Review
For citations:
Novikova N.A., Shilova A.S. THE SPECIFICS OF PRESCRIBING TRIPLE ANTITROMBOTIC THERAPY WITH RIVAROXABAN IN PATIENTS WITH ATRIAL FIBRILLATION AFTER CORONARY ARTERY STENTING. Aterotromboz = Atherothrombosis. 2017;(1):114-121. (In Russ.) https://doi.org/10.21518/2307-1109-2017-1-114-121
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