Korean Circ J.  2019 Aug;49(8):645-656. 10.4070/kcj.2019.0185.

The Role of Novel Oral Anticoagulants and Antiplatelet Therapy after Percutaneous Coronary Intervention: Individualizing Therapy to Optimize Outcomes

• Shlofmitz
• Shlofmitz
• Lee MS

• KMID: 2456861
• DOI: http://doi.org/10.4070/kcj.2019.0185

Abstract

The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the tradeoff is an increased risk for bleeding while on DAPT. The addition of a novel oral anticoagulant (NOAC) further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on NOAC must be assessed and therapy individualized to ensure optimal therapy for each unique situation. Patients on NOAC undergoing PCI should undergo routine assessment with intravascular imaging as the role of high-risk lesion-related features have increased importance prior to determining optimal duration of treatment with DAPT. We review the best practices for the pharmacologic management of patients requiring anticoagulation with NOAC who are treated with PCI and require antiplatelet therapy.

Keyword

Antiplatelet therapy; Oral anticoagulant; Non-vitamin K antagonist oral anticoagulants; Percutaneous coronary intervention

MeSH Terms

Anticoagulants*
Hemorrhage
Humans
Myocardial Infarction
Percutaneous Coronary Intervention*
Practice Guidelines as Topic
Risk Assessment
Stents
Stroke
Thrombosis
Anticoagulants

Figure

• 

  Figure 1 Risk-benefit assessment for individualized approach to pharmacotherapy following PCI. PCI = percutaneous coronary intervention.

• 

  Figure 2 Approach to patients requiring PCI on oral anticoagulant therapy. DAPT = dual antiplatelet therapy; DES = drug-eluting stent; IVUS = intravascular ultrasound; NOAC = novel oral anticoagulant; OAC = oral anticoagulant; OCT = optical coherence tomography; PCI = percutaneous coronary intervention.

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