Aspects of antithrombotic therapy in patients with atrial fibrillation and coronary disease
Coronary artery disease (CAD) is the most common cardiovascular disease, while atrial fibrillation (AF) is the most frequent type of cardiac arrhythmia. These pathologies possess common risk factors, such as hypertension, diabetes mellitus, sleep apnea, obesity and smoking. Moreover, inflammation is essential for the development of both diseases. The prevalence of CAD in patients with AF ranges from 17 to 46.5%, while the prevalence of AF in patients with CAD is relatively low and is estimated to be only 0.2-5%. AF is a known factor of unfavorable short-term and long-term prognosis in patients with acute myocardial infarction (AMI) and is associated with a significant increase in overall mortality. Cardiac arrhythmias are not infrequent after cardiac surgery and occur in approximately 30-40% of patients undergoing coronary artery bypass surgery. It is estimated that 5-15% of patients with AF will ever require percutaneous coronary intervention and, subsequently, triple antithrombotic therapy with aspirin, clopidogrel or ticagrelor and oral anticoagulant. This demands a very careful consideration of balanced antithrombotic therapy, taking into account the high risk of bleeding, the risk of stroke and stent thrombosis with subsequent acute coronary syndrome. The concomitant administration of oral anticoagulants with antiplatelet drugs, and, particularly, the triple therapy, significantly increases the absolute risk of serious bleeding. In addition, heavy bleeding is associated with a five-fold increase in the risk of an adverse outcome after acute coronary syndrome. The co-presence of AF and CAD worsens the prognosis even in patients undergoing thorough treatment.