Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) require treatment with anticoagulation to reduce the risk of thromboembolic events and death. Previous guidelines recommended that these patients receive triple therapy with warfarin, a P2Y12 inhibitor such as clopidogrel or ticagrelor, and aspirin. However, this approach is associated with a significant risk of bleeding. The authors of the study sought to compare the efficacy of dual antithrombotic therapy with dabigatran, an oral, direct thrombin inhibitor, and a P2Y12 inhibitor versus triple therapy that included warfarin. Patients were treated for an average of about 12 months, and the results of the trial indicated that dual therapy that included dabigatran had a significantly lower risk of bleeding compared to triple therapy with warfarin. Additionally, dual therapy with dabigatran was non-inferior to triple therapy with warfarin with respect to prevention of stroke, thromboembolic events, or death. The relative risk of bleeding and thromboembolic events must be carefully weighed on an individual basis. Physicians must take all patient risk factors into account before initiating anticoagulation. Nonetheless, the results of this study indicate that clinicians can be comfortable treating patients with atrial fibrillation who have undergone PCI with dual therapy that includes dabigatran, as these patients will achieve a relatively safe and therapeutic degree of anticoagulation.



Cannon, CP, Bhatt, DL, Oldgren, J, et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med 2017; 377:1513-1524

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