Antithrombotic Therapy for Gerontal Patients with Atrial Fibrillation and Coronary Artery Disease: Evidence-Based Practice_Chinese Journal of Evidence-Based Medicine

Authors：

 LIUYang , ZHANGShao-min ,  WUJin-hui

Geriatrics Center/Department of Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

WUJin-hui, Email: wujinhui@scu.edu.cn

Keywords：

Atrial fibrillation combined coronary heart disease; Antithrombotic therapy; Antiplatelet therapy; Gerontal patient

DOI：

10.7507/1672-2531.20140245

Video：

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Objective To retrieve currently-available best evidence to select the treatment plan of antithrombotic therapy for a gerontal patient lately admitted because of atrial fibrillation (AF) and coronary artery disease (CAD), and to provide references for clinical treatment. Methods We comprehensively searched PubMed, MEDLINE (Ovid), EMbase and The Cochrane Library (Issue 5, 2014) up to May 2014, for relevant evidence about antithrombotic therapy for patients with AF and CAD. After analysis and assessment, we developed the plan of the patient's antithrombotic therapy. Results Current evidence showed no best treatment plan of antithrombotic therapy for patients with AF and CAD. Conclusion Correct evaluation of the risks of thrombosis and bleeding is the key point of beneficial antithrombotic therapy for patients with AF and CAD.

Citation： LIUYang, ZHANGShao-min, WUJin-hui. Antithrombotic Therapy for Gerontal Patients with Atrial Fibrillation and Coronary Artery Disease: Evidence-Based Practice. Chinese Journal of Evidence-Based Medicine, 2014, 14(12): 1533-1536. doi: 10.7507/1672-2531.20140245 Copy

1.	Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease:collaborative meta-analysis of individual participant data from randomized trials. Lancet, 2009, 373:1849-1860.
2.	Thrombosis prevention trials:randomized trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischemic heart disease in men at increased risk. The Medical Research Council's General Practice Research Framework. Lancet, 1998, 351:233-241.
3.	Baigent C, Sudlow C, Collins R, et al. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ, 2002, 324:71-86.
4.	Gent M, Beaumont D, Blanchard J, et al. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet, 1996, 348:1329-1339.
5.	Pokushalov E, Romanov A, Katritsis DG, et al. Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation:a randomized comparison. Heart Rhythm, 2013, 10:1280-1286.
6.	Mant J, Hobbs FD, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA):a randomized controlled trial. Lancet, 2007, 370:493-503.
7.	Friberg L, Rosenqvist M, Lip GY, et al. Net clinical benefit of warfarin in patients with atrial fibrillation:a report from the Swedish atrial fibrillation cohort study. Circulation, 2012, 125:2298-2307.
8.	Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation):developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 2006, 114:257-354.
9.	Hart RG, Pearce LA, Aguilar MI, et al. Meta-analysis:antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med, 2007, 146:857-867.
10.	Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVEW):a randomised controlled trial. Lancet, 2006, 367:1903-1912.
11.	Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med, 1998, 339:1665-1671.
12.	Hess CN, Broderick S, Piccini JP, et al. Antithrombotic therapy for atrial fibrillation and coronary artery disease in older patients. Am Heart J, 2012, 164(4):607-615.
13.	DeEugenio D, Kolman L, Decaro M, et al. Risk of major bleeding with concomitant dual antiplatelet therapy after percutaneous coronary intervention in patients receiving long-term warfarin therapy. Pharmacotherapy, 2007, 27:691-696.
14.	Rubboli A, Colletta M, Herzfeld J, et al. Peri-procedural and medium-term antithrombotic strategies in patients with an indication for long-term anticoagulation undergoing coronary angiography and intervention. Coron Artery Dis, 2007, 18:193-199.
15.	Nguyen MC, Lim YL, Walton A, et al. Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary Events:is it safe and effective to use just one antiplatelet agent? Eur Heart J, 2007, 28:1717-1722.
16.	Huber K, Airaksinen KJ, Cuisset T, et al. Antithrombotic therapy in patients with atrial fibrillation undergoing cornary stenting:similarities and dissimilarities between North America and Europe. Thromb Haemost, 2011, 106:569-571.
17.	Faxon DP, Eikelboom JW, Berger PB, et al. Consensus document:antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting:A North-American perspective. Thromb Haemost, 2011, 106:572-584.
18.	Andrade JG, Deyell MW, Khoo C, et al. Cairns JA. Risk of bleeding on triple antithrombotic therapy after percutaneous coronary intervention/stenting:a systematic review and meta-analysis. Can J Cardiol, 2013, 29:204-212.
19.	Zhao HJ, Zheng ZT, Wang ZH, et al. "Triple therapy" rather than "triple threat":a meta-analysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment. Chest, 2011, 139:260-270.

1. Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease:collaborative meta-analysis of individual participant data from randomized trials. Lancet, 2009, 373:1849-1860.
2. Thrombosis prevention trials:randomized trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischemic heart disease in men at increased risk. The Medical Research Council's General Practice Research Framework. Lancet, 1998, 351:233-241.
3. Baigent C, Sudlow C, Collins R, et al. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ, 2002, 324:71-86.
4. Gent M, Beaumont D, Blanchard J, et al. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet, 1996, 348:1329-1339.
5. Pokushalov E, Romanov A, Katritsis DG, et al. Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation:a randomized comparison. Heart Rhythm, 2013, 10:1280-1286.
6. Mant J, Hobbs FD, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA):a randomized controlled trial. Lancet, 2007, 370:493-503.
7. Friberg L, Rosenqvist M, Lip GY, et al. Net clinical benefit of warfarin in patients with atrial fibrillation:a report from the Swedish atrial fibrillation cohort study. Circulation, 2012, 125:2298-2307.
8. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation):developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 2006, 114:257-354.
9. Hart RG, Pearce LA, Aguilar MI, et al. Meta-analysis:antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med, 2007, 146:857-867.
10. Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVEW):a randomised controlled trial. Lancet, 2006, 367:1903-1912.
11. Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med, 1998, 339:1665-1671.
12. Hess CN, Broderick S, Piccini JP, et al. Antithrombotic therapy for atrial fibrillation and coronary artery disease in older patients. Am Heart J, 2012, 164(4):607-615.
13. DeEugenio D, Kolman L, Decaro M, et al. Risk of major bleeding with concomitant dual antiplatelet therapy after percutaneous coronary intervention in patients receiving long-term warfarin therapy. Pharmacotherapy, 2007, 27:691-696.
14. Rubboli A, Colletta M, Herzfeld J, et al. Peri-procedural and medium-term antithrombotic strategies in patients with an indication for long-term anticoagulation undergoing coronary angiography and intervention. Coron Artery Dis, 2007, 18:193-199.
15. Nguyen MC, Lim YL, Walton A, et al. Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary Events:is it safe and effective to use just one antiplatelet agent? Eur Heart J, 2007, 28:1717-1722.
16. Huber K, Airaksinen KJ, Cuisset T, et al. Antithrombotic therapy in patients with atrial fibrillation undergoing cornary stenting:similarities and dissimilarities between North America and Europe. Thromb Haemost, 2011, 106:569-571.
17. Faxon DP, Eikelboom JW, Berger PB, et al. Consensus document:antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting:A North-American perspective. Thromb Haemost, 2011, 106:572-584.
18. Andrade JG, Deyell MW, Khoo C, et al. Cairns JA. Risk of bleeding on triple antithrombotic therapy after percutaneous coronary intervention/stenting:a systematic review and meta-analysis. Can J Cardiol, 2013, 29:204-212.
19. Zhao HJ, Zheng ZT, Wang ZH, et al. "Triple therapy" rather than "triple threat":a meta-analysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment. Chest, 2011, 139:260-270.

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