Advances Of Antithrombotic Therapy In Atrial Fibrillation And Acute Coronary Syndrome

Atrial fibrillation(AF) is the most prevalent cardiac arrhythmia, and a significant number of AF patients have concomitant acute coronary syndrome(ACS). Due to the thrombosis in atrial fibrillation and coronary thrombus formation mechanism is different, Oral anticoagulants(OAC)given alone is not effective to prevent coronary ischemic events, whereas antiplatelet medications is inferior to VKA in the prevention of thromboembolism in AF patients. As a consequence, combinations of antithrombotic drugs need to be considered in patients with AF and ACS. It is not surprising that a combination of anticoagulants with antiplatelet drugs increases bleeding risk. The key challenge is to identify the best combination and dose to keep bleeding risk low while optimizing the antithrombotic effect for both thromboembolism in AF and prevention of stent thrombosis. In recent years, new oral anticoagulants(NOAC) and novel P2Y12 receptor inhibitors(e.g. ticagrelor, prasugrel) appear to antithrombotic field with new solutions, which have been shown to be more effective than warfarin and clopidogrel but with higher bleeding risks,are also now recommended in recent guideline updates for AF or ACS and add further complexity. This review aims to summarize the advance of antithrombotic therapy in atrial fibrillation and acute coronary syndrome.