Triple antithrombotic therapy in patients with atrial fibrillation and coronary artery disease
Trojna antitrombotička terapija kod bolesnika sa atrijalnom fibrilacijom i koronarnom bolešću
Milan Pavlović, Vladimir Stojanović, Nebojša Krstić, Snežana Ćirić-Zdravković, Danijela Đorđević-Radojković, Miodrag Damjanović, Goran Koraćević, Svetlana Apostolović, Sonja Šalinger-Martinović, Teodora Stanojlović, Miomir Ranđelović, Lazar Todorović
(+8 others)
2014
Srce i krvni sudovi
Klinika za kardiovaskularne bolesi, Klinički centar Niš Pregledni rad Atrijalna ibrilacija je najčešći razlog oralne anikoagulantne terapije i 20% ovih bolesnika ima pridruženu koronarnu bolest. Bolesnici sa atrijalnom ibrilacijom i akutnim koronarnim sindrom ili ugrađenim koronarnim stentom treba da dobiju oralnu anikoagulantnu terapiju u prevenciji kardioembolizma i dvojnu anitrombocitnu terapiju u sekundarnoj prevenciji akutnog koronarnog sindroma i u prevenciji tromboze koronarnog stenta.
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... otokol trojne anitromboičke terapije ovih bolesnika nije ispiivan u velikim randomizovanim studijama i postoje samo konsenzusi radnih grupa, u vezi načina sprovođenja trojne terapije. Potrebno je trajanje trojne anitromboičke terapije maksimalno skraii, radi smanjenja hemoragijskog rizika i zato treba kada god je moguće u perkutanoj koronarnoj intervenciji koriisii BMS stent neobložen lekom. trojna anitromboička terapija, rizik kardioembolizma Sažetak Ključne reči: Adresa za korespodenciju: Milan Pavlović, Branka Miljkovića 51, Clinic for Cardiovascular diseases, Clinical center Niš According to current guidelines, all paients with a recent coronary ar tery stent placement should receive double aniplatelet therapy with a combina ion of aspirin plus clopidogrel to reduce the likelihood of acute and subacute stent thrombosis. The length of treatment depends on the type of the stent, with bare metal stents requiring at least 1 month and drug-eluing stents requiring 6 months of both aniplatelet drugs. The length of treatment of paients with acute coronary syndrome is 12 months of dual anithrombocite drugs. Atrial ibrillaion carries a high risk for thromboembolic events and any paient with at least two moderate risk factors should be on oral anicoagulaion with a vitamin K antagonist. Since atrial ibrillaion and coronary artery disease with stent placement are common, it is not infrequent to treat paients with both these condiions, where triple anithromboic therapy with aspirin, clopidogrel and oral antagonist of vitamin K would be needed. However, concerns about increased bleeding risk do exist and clinicians are uncertain about how to manage this dif cult clinical situaion-especially since there are no large randomised trials to guide clini cal pracice regarding this paricular issue.
doi:10.5937/siks1402162p
fatcat:4lgn6fsrm5fi5fuvg2jdg3wi6u
