Triple Antithrombotic Therapy in Patients with Acute Coronary Syndrome and Atrial Fibrillation – Balancing Risks and Benefits

Backround: Optimal antithrombotic therapy in patients with AF who undergo coronary stenting for an ACS has been a subject of constant change, with the addition of numerous trials in recent years. Objectives: The aim of our study was to assess current antithrombotic treatment in patients with AF and ACS treated with PCI. Material and methods: We performed a observational retrospective study on patients with nonvalvular AF, ACS and PCI between January 2017 and May 2019. We assessed both ischemic risk (IR) and haemorrhagic risk (HR) according to the 2018 ESC guidelines strategies. Results: 184 patients with nonvalvular AF and ACS treated with PCI were eligible for inclusion. In the whole cohort the HR was significantly higher than the IR (3.66+/-1.15 respectively 2.84+/- 1.15, p < 0.001). NSTEMI carries both the highest IR and HR (p<0.05). The majority of patients (88.04%) received triple antithrombotic therapy mostly for one month (39%). Main drug combination used was Aspirin, lopidogrel, antivitamin K (48.48%). Conclusions: In our registry of AF patients with ACS treated with PCI, triple antithrombotic therapy is still the strategy of choice with an initial duration of one month. In our cohort, HR is higher than IR, NSTEMI carrying the highest risks out of all the ACS.