Anticoagulation Myth Busters

MYTH

“Aspirin should always be continued with an oral anticoagulant if a patient has cardiovascular disease”

REALITY

“Combining oral anticoagulant (OAC) with antiplatelet therapy is not uncommon; up to 15% of patients with atrial fibrillation (AF) have a history of myocardial infarction. Between 5% and 15% of patients with AF will require coronary artery stent implantation at some point during their lifetime.”1

It is accepted that combining oral anticoagulants (OAC) with antiplatelet therapy significantly increases bleeding risk; as such the shortest possible duration of combination therapy should be prescribed as per European Society of Cardiology recommendations. Of note, when a NOAC is prescribed in combination with antiplatelet therapy, the lowest dose effective for stroke prevention in AF is recommended. 1

If there is any uncertainty regarding the indication(s) for use or intended treatment durations, please refer to cardiology or haematology specialist advice and/or clarification.

OAC monotherapy is recommended in AF patients with stable cardiovascular disease (CVD) without acute coronary syndrome (ACS) and/or coronary intervention in the previous 12 months.1-3

REFERENCES
  1.  Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893-962.
  2. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary. Europace. 2018.
  3. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Kardiol Pol. 2017;75(12):1217-99.
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