Managing the anticoagulated patient with atrial fibrillation at high risk of stroke who needs coronary intervention

doi:10.1136/bmj.39533.570602.BE

Published 12 September 2008, doi:10.1136/bmj.39533.570602.BE
Cite this as: BMJ 2008;337:a840

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Managing the anticoagulated patient with atrial fibrillation at high risk of stroke who needs coronary intervention

Gregory Y H Lip, professor of cardiovascular medicine

¹ University Department of Medicine, City Hospital, Birmingham B18 7QH

g.y.h.lip@bham.ac.uk

The first 150 words of the full text of this article appear below.

Given the common association between atrial fibrillation andcoronary artery disease, more patients with atrial fibrillationare presenting with acute coronary syndromes or need percutaneouscoronary intervention, with or without coronary stenting. Patientswith atrial fibrillation who are at high risk of stroke benefitgreatly from thromboprophylaxis with oral anticoagulants.¹Dualantiplatelet treatment—aspirin plus a thienopyridine (clopidogrelor less often ticlopidine)—is needed after acute coronarysyndrome to prevent recurrent cardiac ischaemia (recommendedfor 12 months²) or stent thrombosis (a minimum of four weeksfor bare metal stents and 6-12 months for drug eluting stentsafter elective procedures³). But adding dual antiplatelet treatmentto the regimen of someone already receiving oral anticoagulationfor stroke prevention increases the risk of life threateningbleeds. For example, when warfarin is combined with aspirinin patients with peripheral vascular disease, the absolute riskof life threatening bleeding increases from 1.2% to 4% over. . . [Full text of this article]