What to use in patients with ischaemic heart disease and atrial fibrillation – anticoagulation, antiaggregation or both?

Czech version

Authors: R. Lábrová; J. Špinar
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno
Published in: Kardiol Rev Int Med 2016, 18(1): 47-51
Category: Cardiology Review

Overview

A combination of atrial fibrillation and ischaemic heart disease is quite common and antiaggregation or anticoagulation treatment should improve the prognosis of the patients. However, clear evidence is missing and recommendations contained in official guidelines sometimes differ. There are no clinical trials comparing warfarin and new anticoagulants (NOAC) in patients after coronary intervention, and there are also no data about the combination of NOAC with new antiaggregation drugs such as ticagrelor or prasugrel. The combination of antiaggregation (mono or dual) with NOAC or warfarin significantly increases the risk of bleeding, and therefore the intensity and the duration of treatment should be individualised and scoring systems such as CHA2DS2-VASc or HAS-BLED should be used. Anticoagulation alone (preferably NOAC) should be given to patients with chronic ischaemic heart disease (> 1 year) and atrial fibrillation.

Keywords:
atrial fibrillation – ischaemic heart disease – anticoagulation – antiagregation

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