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Finding the sweet spot of anticoagulation in AF patients with ACS

Patients with both atrial fibrillation (AF) and acute coronary syndrome (ACS) are constantly trapped between the Scylla of bleeding and Charybdis of ischaemic events. The large AUGUSTUS trial showed that dual therapy with a direct oral anticoagulant (DOAC) and a P2Y12 inhibitor is safer than triple therapy with aspirin or VKA use in this challenging patient population [1].

Prof. Renato D. Lopes (Duke University School of Medicine, USA) reviewed this challenging patient population and raised 2 important questions: "whether we should use triple or double therapy for patients with AF and ACS/percutaneous coronary intervention (PCI), and what drug combination we should prescribe" [2]. Patients with AF and coronary artery disease have overlapping indications for antithrombotic therapy. Coronary stenting in patients with AF and a high stroke risk is a problem because to prevent both stent thrombosis and stroke, a combination of dual antiplatelet thera...



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