The patient with atrial fibrillation undergoing percutaneous angioplasty: triple therapy or new therapeutic strategies?

The management of antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a challenge cardiologists face daily. The main difficulty is represented by finding the right balance between the prevention of thrombotic risk and the inevitable increase in bleeding. Most guidelines recommend the use of both oral anticoagulants and dual antiplatelet therapy in combination (triple therapy) in patients with FA undergoing PCI, suggesting however immediate use of dual antithrombotic therapy in patients with prevalent bleeding risk. Many studies show that triple therapy is associated with high frequency of major bleeding, thus stimulating the research for new therapeutic strategies. We report the case of a patient suffering from hypertension, dyslipidemia and epistaxis, hospitalized for the onset of angina associated with moderate efforts. Despite scientific evidence to support the use of dual therapy with dabigatran, the patient's detailed clinical history shows that this type of approach has not yet entered into current clinical practice, although the final therapeutic choice is in line with the results of the RE-DUAL PC study (Cardiology).