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Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review

by Paolillo, Roberta , Vallone, Donato Maria , Esposito, Giovanni , Sperandeo, Luca , Sciahbasi, Alessandro , Buongiorno, Federica , Castiello, Domenico Simone , Gragnano, Felice , Narciso, Viviana , Canonico, Mario Enrico , Gargiulo, Giuseppe , Forzano, Imma , Manzi, Lina , Cirillo, Plinio , Simonetti, Fiorenzo , Giugliano, Giuseppe , Spinelli, Alessandra , Florimonte, Domenico , Cristiano, Stefano , Semplice, Federica , Avvedimento, Marisa , Calabrò, Paolo , D’Alconzo, Dario

in Acute coronary syndromes / Aggregation / Anticoagulants / antiplatelet / Atrial fibrillation / Bivalirudin / Blood platelets / Cardiac patients / Care and treatment / Comparative analysis / Coronary heart disease / intracoronary imaging / Ischemia / Medical imaging / Mortality / oral anticoagulant / percutaneous coronary intervention / Prevention / Review / Stroke (Disease) / Transluminal angioplasty / vascular access

2025

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Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review

2025

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Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review

2025

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Journal Article

Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review

Paolillo, Roberta,

Vallone, Donato Maria,

Esposito, Giovanni,

Sperandeo, Luca,

Sciahbasi, Alessandro,

Buongiorno, Federica,

Castiello, Domenico Simone,

Gragnano, Felice,

Narciso, Viviana,

Canonico, Mario Enrico,

Gargiulo, Giuseppe,

Forzano, Imma,

Manzi, Lina,

Cirillo, Plinio,

Simonetti, Fiorenzo,

Giugliano, Giuseppe,

Spinelli, Alessandra,

Florimonte, Domenico,

Cristiano, Stefano,

Semplice, Federica,

Avvedimento, Marisa,

Calabrò, Paolo,

D’Alconzo, Dario

2025

Overview

In the past decades, percutaneous coronary intervention (PCI) has become the most common modality for myocardial revascularization in patients with coronary artery disease (CAD). Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is essential in all patients undergoing PCI to prevent thrombotic complications. A large proportion of patients undergoing PCI also have concomitant atrial fibrillation (AF), thus requiring an oral anticoagulant (OAC) to prevent ischemic stroke or systemic embolism. However, the association between OAC and DAPT further increases the risk of bleeding. Compared with a triple antithrombotic therapy (TAT), dual antithrombotic therapy (DAT) has shown to reduce bleeding events, but at the cost of higher risk of stent thrombosis. In this field, patients with AF undergoing PCI represent a special population with significant challenges, and several strategies are needed to reduce the risk for bleeding complications. In this review, we will discuss both the procedural and antithrombotic strategies to optimize ischemic and bleeding outcomes in patients with AF undergoing PCI.

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Publisher

MDPI AG,MDPI

Subject

Acute coronary syndromes

/ Aggregation

/ Anticoagulants

/ antiplatelet

/ Atrial fibrillation

/ Bivalirudin

/ Blood platelets