Antithrombotic Therapy in Patients With AF Undergoing PCI
A 76-year-old female patient with hypertension, paroxysmal atrial fibrillation (AF) (AF burden of 58% on recent event monitor), and coronary artery disease with prior percutaneous coronary intervention (PCI) to the right coronary artery presented with symptoms of exertional chest pressure and dyspnea for the past 5 days. Her home medications included aspirin 81 mg/d, lisinopril 10 mg/d, warfarin 3.5 mg/d, and atorvastatin 80 mg/d. Her examination noted a regular rhythm with heart rate of 94 bpm and blood pressure of 135/78 mmHg. Her lung fields were clear to auscultation, and there was no gallop. An electrocardiogram showed normal sinus rhythm with Q waves and T wave inversions in inferior leads (Figure 1). Initial cardiac troponin I was 1.8 ng/ml (reference range <0.057 ng/ml). Coronary angiography revealed 95% stenosis in a previously stented segment of the right coronary artery (Figure 2). PCI was performed with placement of a 3.0 mm second-generation everolimus-eluting stent.
Based on results from the AUGUSTUS (Antithrombotic Therapy After Acute Coronary Syndrome or PCI in Atrial Fibrillation) trial, what is the optimal long-term antithrombotic regimen for this patient?