The American College of Cardiology (ACC) is celebrating the holiday season with a new gift for cardiologists: antithrombotic therapy recommendations for patients with atherosclerotic cardiovascular disease (ASCVD) and concomitant atrial fibrillation (AFib) or venous thromboembolism (VTE).
The guidance, published in the Journal of the American College of Cardiology, “highlights the challenges with choosing optimal antithrombotic regimen for patients needing an anticoagulant and antiplatelet therapy, including the increased risk of major bleeding associated with triple antithrombotic therapy.”
In fact, the ACC guidelines include a recommendation against the use of triple antithrombotic therapy for most patients and urges physicians to consider dual antithrombotic therapy consisting of an anticoagulant and a P2Y12 inhibitor when patients require both an anticoagulant and antiplatelet therapy following percutaneous coronary intervention (PCI).
Much of the guidance focusses on four clinical scenarios:
- A patient with AFib who is already on anticoagulant therapy and now needs PCI and antiplatelet therapy
- A patient on antiplatelet therapy with new-onset AFib who requires an oral anticoagulant
- A patient with prior VTE who is already on anticoagulant therapy and now needs PCI and antiplatelet therapy
- A patient on antiplatelet therapy for ASCVD with new VTE that will require an anticoagulant
“This is a complex topic, and we have attempted to cite the literature to offer direct guidance when possible and to highlight areas in which clinical judgement is needed,” wrote writing committee chair Dharam J. Kumbhani, MD, an assistant professor of medicine at UT Southwestern Medical Center, and colleagues. “We hope this document will aid in the management of this common yet challenging subset of patients.”
Read the full recommendations here. A longer summary has also been published on the ACC website.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.