Contact: Dana Kauffman, dkauffman@acc.org, 202-375-6294

WASHINGTON (Dec 18, 2020) -

Around 1 in 4 individuals will develop atrial fibrillation (AF) during their lifetime, which increases their risk of stroke fourfold to fivefold. For most patients with AF, treatment with oral anticoagulant (OAC) therapy is associated with significantly lower stroke rates compared with aspirin or placebo. Like AF, venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, has a high overall incidence estimated to be one to two per 1,000 person-years and is usually treated with OAC as well. Choosing the optimal antithrombotic regimen for patients with atherosclerotic cardiovascular disease and concomitant AF or VTE who require an anticoagulant and antiplatelet therapy can be a challenge for clinicians. This 2020 Expert Consensus Decision Pathway (ECDP) aims to fill the gap for much-needed guidance on antithrombotic therapy for this patient population.

This ECDP highlights that patients with either AF or VTE undergoing percutaneous coronary intervention have usually been treated with an anticoagulant and dual antiplatelet therapy (DAPT), so called “triple therapy.” Support for this practice came from older clinical trials that suggested an OAC alone was not an optimal treatment for those undergoing percutaneous coronary intervention and, similarly, that DAPT was not an optimal treatment for AF or VTE. However, triple antithrombotic therapy significantly increases the risk of bleeding and the writing committee for this document recommends against the routine use of triple antithrombotic therapy for most patients.

Because major bleeding is associated with an up to fivefold increased risk of death following an acute coronary syndrome, the writing committee for this document found it imperative to identify the optimal antithrombotic therapy for patients with atherosclerotic cardiovascular disease and concomitant AF or VTE requiring an anticoagulant. The goal of antithrombotic therapy for these patients is to maintain antithrombotic efficacy while mitigating bleeding. This ECDP provides guidance and recommendations for the best antithrombotic therapy regimen in this patient population.

The 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease will publish online in the Journal of the American College of Cardiology on Friday, Dec. 18 at 2:00 p.m. EST.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

The Journal of the American College of Cardiology ranks among the top cardiovascular journals in the world for its scientific impact. JACC is the flagship for a family of journals—JACC: Cardiovascular Interventions, JACC: Cardiovascular Imaging, JACC: Heart Failure, JACC: Clinical Electrophysiology, JACC: Basic to Translational Science, JACC: Case Reports and JACC: CardioOncology—that prides themselves in publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.

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