To the Editor Recommendations on oral anticoagulation in patients with atrial fibrillation historically came from balancing the annual risk of cerebrovascular embolism (CHA2DS2-VASc score of 2, approximately 2%; CHA2DS2-VASc score of 4, approximately 4%) vs major bleeding (1.6% to 3.6%). The use of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention without atrial fibrillation is recommended based on randomized studies including more than 220 000 patients.1 Recently, trials on the use of double antithrombotic therapy (DAT) and triple antithrombotic therapy (TAT) in patients with both atrial fibrillation and the need for DAPT univocally demonstrated lower bleeding rates when using DAT compared with TAT. However, none of these trials was powered for efficacy regarding ischemic end points.
Reinstadler SJ, Metzler B, Klug G. Antithrombotic Strategies in Patients With Atrial Fibrillation and Percutaneous Coronary Intervention. JAMA Cardiol. 2021;6(2):240–241. doi:10.1001/jamacardio.2020.4753
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