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Antithrombotic Therapy in Patients with ACS and Atrial Fibrillation: A Challenge in Clinical Practice

Luciana V Armaganijan, MD1¸2, and Renato D Lopes, MD, PhD2¸3

Atrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia in clinical practice. A proportion of AF cases (20–30%) is associated with coronary artery disease (CAD). Several studies have shown that AF in the setting of myocardial infarction (MI) is associated with worse short- and long-term outcomes [1,2]. It is well established that patients with AF who are at moderate-to-high risk of thromboembolic events should be treated with oral anticoagulants [3]. A combination of aspirin plus clopidogrel constitutes the optimal strategy following ACS, particularly in those who undergo stent implantation [4]. However, in patients with both AF and ACS, concerns have arisen about the efficacy and safety of triple therapy, currently defined as aspirin plus clopidogrel and warfarin. The trade-off between preventing ischemic events and avoiding bleeding is a challenge in clinical practice when treating these patients.

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