Beginning the Journey to Find Optimal Antithrombotic Regimens for Korean Patients with Atrial Fibrillation after Percutaneous Coronary Intervention

Abstract

https://e-kcj.org Dual antiplatelet therapy (DAPT) using aspirin and P2Y12 receptor inhibitor has been proven to reduce recurrent ischemic events, such as stent thrombosis and myocardial infarction (MI), after percutaneous coronary intervention (PCI), but it is less effective for prevention of ischemic stroke and systemic embolism in patients with atrial fibrillation (AF) when compared with oral anticoagulation therapy (OAC).1) Triple antithrombotic therapy (TAT) with OAC and DAPT has been recommended in treatment guidelines for patients with AF after PCI. However, this approach could increase the risk of excessive major bleeding. In Korea, only DAPT was prescribed in more than 90% of patients with AF after PCI during the era of vitamin K antagonist (VKA) for OAC.2) Discrepancies between guidelines and realworld clinical practice might be associated with bleeding concerns including intracranial hemorrhage and inconvenience to use of VKA such as narrow therapeutic window, drug and dietary interactions, and intra-patient variability requiring frequent monitoring.