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  • Should patients with atrial fibrillation and stable coronary artery disease receive an oral anticoagulant, an antiplatelet or both?

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EBM verdict
General medicine
Should patients with atrial fibrillation and stable coronary artery disease receive an oral anticoagulant, an antiplatelet or both?
  1. Mark T Mills
  1. Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Mark T Mills, Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK; marktmills1{at}gmail.com

https://doi.org/10.1136/bmjebm-2020-111376

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    Patients with atrial fibrillation necessitating anticoagulation frequently develop concomitant stable coronary artery disease requiring antiplatelet therapy and vice versa. The optimal choice of antithrombotic therapy in this cohort has been unclear. Which therapy is most effective at reducing mortality and thrombotic events while avoiding a disproportionate increase in bleeding risk?

    EBM verdict

    EBM Verdict on: Antithrombotic therapy for atrial fibrillation with stable coronary disease. N Engl J Med 2019;381:1103-–1113. doi: 10.1056/NEJMoa1904143.

    In patients with atrial fibrillation and stable coronary artery disease, monotherapy with rivaroxaban is non-inferior to combination therapy with rivaroxaban and an antiplatelet in terms of preventing death and cardiovascular events. Rivaroxaban monotherapy is associated with less major bleeding.

    In patients with atrial fibrillation (AF) who have recently undergone percutaneous coronary intervention (PCI) and have a high ischaemic risk, current guidelines recommend triple therapy (with aspirin, a P2Y12 inhibitor and an oral anticoagulant (OAC)) for the shortest duration possible after PCI.1 Following this, combination therapy with an OAC and a P2Y12 inhibitor is recommended for up to a …

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    Footnotes

    • Contributors MTM is the sole author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.