Strategies for the Use of Antithrombotic Drugs in Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention. A review Article

Abstract

Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) pose a significant therapeutic challenge due to the need for effective anticoagulation and antiplatelet therapy. This review examines the strategies used to manage anticoagulation in AF patients undergoing PCI, focusing on dual antiplatelet therapy (DAPT), anticoagulants, and the complexities of combining these therapies. We explore the use of various anticoagulants, including unfractionated heparin (UFH), low molecular weight heparin (LMWH), bivalirudin, warfarin, and direct oral anticoagulants (DOACs), with particular attention to their mechanisms of action, dosing regimens, and potential risks. The review also discusses the use of DAPT in combination with anticoagulation therapy, highlighting the increased bleeding risks associated with these therapies. The duration of DAPT and the option of triple therapy, combining anticoagulation with DAPT, are examined, with a focus on optimizing the duration of treatment to reduce complications. Key challenges, including bleeding risks, kidney function, and the choice of anticoagulant, are addressed, emphasizing the need for individualized treatment plans. Based on the evidence reviewed, we propose recommendations for managing anticoagulation in AF patients undergoing PCI, stressing the importance of balancing thromboembolic risk with bleeding complications. This review aims to provide a comprehensive framework for clinicians in selecting the most appropriate anticoagulation strategy for AF patients undergoing PCI.