Non–Vitamin K Antagonist Preferred in Patients With Nonvalvular Atrial Fibrillation and Indication for Aspirin Therapy
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Article, see p 1117
Recent trials of patients with atrial fibrillation (AF) have convincingly shown that anticoagulation with non–vitamin K antagonists or so-called novel oral anticoagulants (NOACs) are at least as effective as oral vitamin K antagonism by warfarin in reducing the risk of cardioembolic stroke and systemic embolism, but with a lower risk of serious bleeding events, in particular, intracranial hemorrhage.1
Trial results have been supported by large registry studies in broad populations. AF frequently occurs in patients with underlying heart disease entities. In fact, up to one-third of all patients with AF have an underlying stable coronary artery disease, undergo coronary stenting, or will develop an acute coronary syndrome necessitating treatment with single- or 2-antiplatelet agents. The intersection between the 2 disease entities, AF and coronary artery disease, has gained a lot of attention and clinical and scientific interest recently. In patients with a recent acute coronary syndrome or stent procedure with or without AF, dual-antiplatelet therapy has been advocated to protect patients from stent thrombosis and recurrent ischemic events. However, adding anticoagulation for stroke prevention on …