Advances Of Antithrombotic Treatment In Patients With Acute Coronary Syndrome Combined And Atrial Fibrillation

Acute coronary syndrome(ACS)and atrial fibrillation(AF)have many similar risk factors,such as age,obesity,diabetes mellitus,hypertension,obstructive sleep apnea syndrome.In clinical practice,we often encounter patients with acute coronary syndrome complicated with atrial fibrillation.These patients have complex conditions and many contradictions in treatment.It is necessary to evaluate their bleeding risk,the risk of ischemic stroke and stent thrombosis comprehensively when they are treated.Thrombosis is the first cause of adverse events of acute coronary syndrome,which can often cause serious events such as acute heart events or even death.For patients with acute coronary syndrome,thrombolysis or interventional operation are often needed to recanalize blood vessels to save myocardium,and long-term antiplatelet therapy is also needed to reduce the occurrence of adverse events such as angina pectoris,myocardial infarction and sudden death.For patients with atrial fibrillation,oral anticoagulants are needed to reduce the occurrence of adverse events such as ischemic stroke.The risk of bleeding(includinggastrointestinal and intracranial hemorrhage)in patients with combination of anticoagulants and antiplatelet drugs is greatly increased,but both treatments are indispensable.So for patients with acute coronary syndrome complicated with atrial fibrillation,how can we balance the benefits and risks of antithrombotic therapy to maximize the benefits of patients? In recent years,the emergence of new P2Y12 receptor inhibitors(such as ticagrilol,prasugrel)and new oral anticoagulants(NOAC)have provided more alternative pathways for antithrombotic therapy.It has been gradually confirmed that the clinical benefits of new P2Y12 receptor inhibitors and NOAC in patients with ACS and AF are better than clopidogrel and warfarin,and they are recommended in the recently updated guidelines for the management of patients with acute coronary syndrome and the prevention of atrial fibrillation and stroke,respectively.However,the use of these new antithrombotic drugs increases the risk of bleeding,which leads to the complication of acute coronary syndrome.Antithrombotic therapy in patients with atrial fibrillation has become more contradictory.This article reviews the antithrombotic therapy for ACS patients with AF.