Chronic Coronary Syndrome and New-Onset Atrial Fibrillation or Venous Thromboembolism: How Best to Manage Antithrombotic Therapy Strategies.

Abstract

The antithrombotic therapy (AT) regime for patients with atrial fibrillation (AF) or venous thromboembolism (VTE) who are in the chronic phase after percutaneous coronary intervention (PCI), either elective or in the context of an acute coronary syndrome (ACS), i.e. 6 and 12 months later respectively, is currently standardised. On the contrary, no specific data nor trial evidence are available as regards the opposite clinical scenario, i.e. patients with chronic coronary syndrome (CCS) on long-term antithrombotic therapy (with either single or dual antiplatelet therapy or dual antithrombotic therapy with aspirin and low-dose rivaroxaban) who develop AF or VTE and therefore an indication for oral anticoagulation (OAC), especially with direct oral anticoagulants (DOAC). In this article, the current recommendations for AT in AF and VTE patients with CCS are summarised, and management strategies for the AT regimes to be applied to CCS patients with new-onset AF or VTE (with indication or not for indefinite OAC) are proposed.