Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation

Kevin Lao, Mercer University College of Pharmacy

The 2016 European Society of Cardiology guidelines recommend a short period of triple therapy (oral anticoagulant [OAC], aspirin, clopidogrel) for patients with atrial fibrillation (AFib) undergoing percutaneous coronary intervention (PCI) with a stent placement. [1]

Contrary to the European guidelines, the American Heart Association guidelines state that it may be reasonable to use clopidogrel with OAC without aspirin in AFib patients with CHA2DS2-VASc score ≥ 2 following PCI based on evidence that showed higher rates of bleeding with triple therapy. [2] Additionally, one previous trial has shown that dual therapy (warfarin + clopidogrel [P2Y12 inhibitor]) was associated with lower incidence of bleeding without increased rates of stent thrombosis in PCI patients compared to triple therapy. [3]

With the availability of the new oral anticoagulant (NOAC), some evidence suggests that NOAC, instead of warfarin, with a P2Y12 inhibitor (i.e. clopidogrel) may be an effective thromboprophylaxis in PCI patients. Therefore, the RE-DUAL PCI trial aimed to compare the efficacy and safety of dual therapy composed of dabigatran and P2Y12 inhibitor among patients with AFib undergoing PCI. [4]

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Long Term Survival of Ischemic Heart Disease Patients Who Undergo Percutaneous Coronary Intervention

Aaron Nethercott, Mercer University College of Pharmacy

Ischemic heart disease (IHD) accounted for almost 380,000 deaths in 2010. According to the 2012 American College of Cardiology Foundation/American Heart Association/American College of Cardiology/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons guidelines for the diagnosis and management of patents with stable ischemic heart disease, the medical management for IHD consists of aspirin, combinations of beta blockers and calcium channel blockers, blood pressure control, and smoking cessation.  The studies reviewed by the guidelines found no difference in survival or myocardial infarction rates between patients who received percutaneous coronary intervention (PCI) and standard medical therapy. Angina in patients with IHD has been shown to be reduce by PCI. [1]

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