Atrial Fibrillation and Coronary Artery Disease: Deciding on The Best Antithrombotic Regimen

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Jason Andrade
Laurent Macle
Marc Dyall


Atrial fibrillation, Anticoagulation, Stroke, Coronary artery disease, Acute Coronary Syndorme, Clopidogrel, ASA, Warfarin, NOAC, Dabigatran, Rivaroxaban, Edoxaban, Apixaban


Atrial fibrillation (AF) is a chronic progressive disease characterized by exacerbations and remissions. Up to 20-30% of patients with AF also have coronary artery disease (CAD). In patients with concomitant AF and CAD, the management of antithrombotic therapy is challenging. Oral anticoagulation (OAC) is indicated for the prevention of AF-related stroke and systemic embolism, whereas antiplatelet therapy is indicated for the prevention of coronary events. Each of these therapeutic avenues offers a relative efficacy benefit (e.g. dual antiplatelet therapy [DAPT] is more effective than OAC alone in reducing cardiovascular death, myocardial infarction, stent thrombosis, and ischemic coronary events in an ACS population), but with a relative compromise (e.g. DAPT is significantly inferior to OAC for the prevention of stroke/systemic embolism in an AF population at increased risk of AF-related stroke). The purpose of this review is to explore the current evidence and rationale for antithrombotic treatment strategies in patients with both AF and CAD.

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