Subscribe to RSS
DOI: 10.1055/s-0041-1726298
Single, Dual, and Triple Antithrombotic Therapy in Cancer Patients with Coronary Artery Disease: Searching for Evidence and Personalized Approaches
![](https://www.thieme-connect.de/media/sth/202108/lookinside/thumbnails/10-1055-s-0041-1726298_02871-1.jpg)
Abstract
Improvement in life expectancy of patients suffering from oncohematologic disorders has turned cancer from an acute into a chronic condition, making the management of comorbidities problematic, especially when it comes to both acute and chronic cardiovascular diseases. Treatment-related adverse events and drug–drug interactions often influence the therapeutic approach of patients with active malignancies and cardiovascular disease. Furthermore, tumor cells and platelets maintain a complex crosstalk that on one hand enhances tumor dissemination and on the other hand induces hemostasis abnormalities. Hence, clinicians should move carefully in the intricate land mines established by patients with active cancer under antithrombotic therapy. To date, there is no consensus on the antithrombotic treatment of patients with cardiovascular diseases and concomitant malignancies. The aim of this review is to collect the available scientific evidence, including the latest clinical trials and guidelines, in order to provide guidance on the management of antithrombotic treatment (both antiplatelet and anticoagulant therapy) in cancer patients with either pre-existent or new-onset coronary artery disease. Randomized-controlled trials on antithrombotic treatment in oncologic populations, which by far have thus far been excluded, have to be promoted to supply recommendations in the oncohematologic setting.
Keywords
dual antiplatelet therapy - bleeding risk - coronary artery disease - anticoagulant therapyPublication History
Article published online:
14 July 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Boele F, Harley C, Pini S, Kenyon L, Daffu-O'Reilly A, Velikova G. Cancer as a chronic illness: support needs and experiences. BMJ Support Palliat Care 2019; (e-pub ahead of print) DOI: 10.1136/bmjspcare-2019-001882.
- 2 Harley C, Pini S, Bartlett YK, Velikova G. Defining chronic cancer: patient experiences and self-management needs. BMJ Support Palliat Care 2015; 5 (04) 343-350
- 3 Darby S, McGale P, Peto R, Granath F, Hall P, Ekbom A. Mortality from cardiovascular disease more than 10 years after radiotherapy for breast cancer: nationwide cohort study of 90 000 Swedish women. BMJ 2003; 326 (7383): 256-257
- 4 Dahlén T, Edgren G, Lambe M. et al; Swedish CML Group and the Swedish CML Register Group. Cardiovascular events associated with use of tyrosine kinase inhibitors in chronic myeloid leukemia: a population-based cohort study. Ann Intern Med 2016; 165 (03) 161-166
- 5 Zamorano JL, Lancellotti P, Rodriguez Muñoz D. et al; ESC Scientific Document Group. 2016 ESC position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J 2016; 37 (36) 2768-2801
- 6 Dai C, Zhou F, Shao JH, Wu LQ, Yu X, Yin XB. Bleeding risk in cancer patients treated with sorafenib: a meta-analysis of randomized controlled trials. J Cancer Res Ther 2018; 14 (Supplement): S948-S956
- 7 Shatzel JJ, Olson SR, Tao DL, McCarty OJT, Danilov AV, DeLoughery TG. Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies. J Thromb Haemost 2017; 15 (05) 835-847
- 8 Valgimigli M, Bueno H, Byrne RA. et al; ESC Scientific Document Group, ESC Committee for Practice Guidelines (CPG), ESC National Cardiac Societies. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018; 39 (03) 213-260
- 9 Knuuti J, Wijns W, Saraste A. et al; ESC Scientific Document Group. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41 (03) 407-477
- 10 Collet JP, Thiele H, Barbato E. et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42 (14) 1289-1367
- 11 Varki A. Trousseau's syndrome: multiple definitions and multiple mechanisms. Blood 2007; 110 (06) 1723-1729
- 12 Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005; 293 (06) 715-722
- 13 Lee EC, Cameron SJ. Cancer and thrombotic risk: the platelet paradigm. Front Cardiovasc Med 2017; 4: 67
- 14 Gasic GJ, Gasic TB, Stewart CC. Antimetastatic effects associated with platelet reduction. Proc Natl Acad Sci U S A 1968; 61 (01) 46-52
- 15 Xu XR, Yousef GM, Ni H. Cancer and platelet crosstalk: opportunities and challenges for aspirin and other antiplatelet agents. Blood 2018; 131 (16) 1777-1789
- 16 Mezouar S, Frère C, Darbousset R. et al. Role of platelets in cancer and cancer-associated thrombosis: experimental and clinical evidences. Thromb Res 2016; 139: 65-76
- 17 Heinmöller E, Schropp T, Kisker O, Simon B, Seitz R, Weinel RJ. Tumor cell-induced platelet aggregation in vitro by human pancreatic cancer cell lines. Scand J Gastroenterol 1995; 30 (10) 1008-1016
- 18 Heinmöller E, Weinel RJ, Heidtmann HH. et al. Studies on tumor-cell-induced platelet aggregation in human lung cancer cell lines. J Cancer Res Clin Oncol 1996; 122 (12) 735-744
- 19 Pearlstein E, Salk PL, Yogeeswaran G, Karpatkin S. Correlation between spontaneous metastatic potential, platelet-aggregating activity of cell surface extracts, and cell surface sialylation in 10 metastatic-variant derivatives of a rat renal sarcoma cell line. Proc Natl Acad Sci U S A 1980; 77 (07) 4336-4339
- 20 Gomes FG, Sandim V, Almeida VH. et al. Breast-cancer extracellular vesicles induce platelet activation and aggregation by tissue factor-independent and -dependent mechanisms. Thromb Res 2017; 159: 24-32
- 21 Ferroni P, Santilli F, Cavaliere F. et al. Oxidant stress as a major determinant of platelet activation in invasive breast cancer. Int J Cancer 2017; 140 (03) 696-704
- 22 Stone RL, Nick AM, McNeish IA. et al. Paraneoplastic thrombocytosis in ovarian cancer. N Engl J Med 2012; 366 (07) 610-618
- 23 Suzuki A, Takahashi T, Nakamura K. et al. Thrombocytosis in patients with tumors producing colony-stimulating factor. Blood 1992; 80 (08) 2052-2059
- 24 Cravioto-Villanueva A, Luna-Perez P, Gutierrez-de la Barrera M. et al. Thrombocytosis as a predictor of distant recurrence in patients with rectal cancer. Arch Med Res 2012; 43 (04) 305-311
- 25 Liu Y, Jiang P, Capkova K. et al. Tissue factor-activated coagulation cascade in the tumor microenvironment is critical for tumor progression and an effective target for therapy. Cancer Res 2011; 71 (20) 6492-6502
- 26 Zhang Q, Liu H, Zhu Q. et al. Patterns and functional implications of platelets upon tumor “education”. Int J Biochem Cell Biol 2017; 90: 68-80
- 27 Mege D, Aubert M, Lacroix R, Dignat-George F, Panicot-Dubois L, Dubois C. Involvement of platelets in cancers. Semin Thromb Hemost 2019; 45 (06) 569-575
- 28 Italiano Jr JE, Richardson JL, Patel-Hett S. et al. Angiogenesis is regulated by a novel mechanism: pro- and antiangiogenic proteins are organized into separate platelet alpha granules and differentially released. Blood 2008; 111 (03) 1227-1233
- 29 Catani MV, Savini I, Tullio V, Gasperi V. The “Janus face” of platelets in cancer. Int J Mol Sci 2020; 21 (03) 788
- 30 Skipper MT, Rubak P, Stentoft J, Hvas AM, Larsen OH. Evaluation of platelet function in thrombocytopenia. Platelets 2018; 29 (03) 270-276
- 31 Mones JV, Soff G. Management of thrombocytopenia in cancer patients. Cancer Treat Res 2019; 179: 139-150
- 32 Panella TJ, Peters W, White JG, Hannun YA, Greenberg CS. Platelets acquire a secretion defect after high-dose chemotherapy. Cancer 1990; 65 (08) 1711-1716
- 33 Dobie G, Kuriri FA, Omar MMA. et al. Ibrutinib, but not zanubrutinib, induces platelet receptor shedding of GPIb-IX-V complex and integrin αIIbβ3 in mice and humans. Blood Adv 2019; 3 (24) 4298-4311
- 34 Fu JB, Tennison JM, Rutzen-Lopez IM. et al. Bleeding frequency and characteristics among hematologic malignancy inpatient rehabilitation patients with severe thrombocytopenia. Support Care Cancer 2018; 26 (09) 3135-3141
- 35 Castaman G, Pieri L. Management of thrombocytopenia in cancer. Thromb Res 2018; 164 (Suppl. 01) S89-S93
- 36 Slichter SJ, Davis K, Enright H. et al. Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients. Blood 2005; 105 (10) 4106-4114
- 37 Weycker D, Hatfield M, Grossman A. et al. Risk and consequences of chemotherapy-induced thrombocytopenia in US clinical practice. BMC Cancer 2019; 19 (01) 151
- 38 Li R, Ren M, Chen N. et al. Presence of intratumoral platelets is associated with tumor vessel structure and metastasis. BMC Cancer 2014; 14: 167
- 39 Sabrkhany S, Griffioen AW, Oude Egbrink MG. The role of blood platelets in tumor angiogenesis. Biochim Biophys Acta 2011; 1815 (02) 189-196
- 40 Battinelli EM, Markens BA, Italiano Jr JE. Release of angiogenesis regulatory proteins from platelet alpha granules: modulation of physiologic and pathologic angiogenesis. Blood 2011; 118 (05) 1359-1369
- 41 Folkman J, Merler E, Abernathy C, Williams G. Isolation of a tumor factor responsible for angiogenesis. J Exp Med 1971; 133 (02) 275-288
- 42 Jurasz P, Alonso-Escolano D, Radomski MW. Platelet--cancer interactions: mechanisms and pharmacology of tumour cell-induced platelet aggregation. Br J Pharmacol 2004; 143 (07) 819-826
- 43 Kut C, Mac Gabhann F, Popel AS. Where is VEGF in the body? A meta-analysis of VEGF distribution in cancer. Br J Cancer 2007; 97 (07) 978-985
- 44 Ballerini P, Dovizio M, Bruno A, Tacconelli S, Patrignani P. P2Y12 receptors in tumorigenesis and metastasis. Front Pharmacol 2018; 9: 66
- 45 Haemmerle M, Stone RL, Menter DG, Afshar-Kharghan V, Sood AK. The platelet lifeline to cancer: challenges and opportunities. Cancer Cell 2018; 33 (06) 965-983
- 46 McCarty OJ, Mousa SA, Bray PF, Konstantopoulos K. Immobilized platelets support human colon carcinoma cell tethering, rolling, and firm adhesion under dynamic flow conditions. Blood 2000; 96 (05) 1789-1797
- 47 Zarà M, Canobbio I, Visconte C, Canino J, Torti M, Guidetti GF. Molecular mechanisms of platelet activation and aggregation induced by breast cancer cells. Cell Signal 2018; 48: 45-53
- 48 Borsig L, Wong R, Feramisco J, Nadeau DR, Varki NM, Varki A. Heparin and cancer revisited: mechanistic connections involving platelets, P-selectin, carcinoma mucins, and tumor metastasis. Proc Natl Acad Sci U S A 2001; 98 (06) 3352-3357
- 49 Palumbo JS, Talmage KE, Massari JV. et al. Platelets and fibrin(ogen) increase metastatic potential by impeding natural killer cell-mediated elimination of tumor cells. Blood 2005; 105 (01) 178-185
- 50 Olsson AK, Cedervall J. The pro-inflammatory role of platelets in cancer. Platelets 2018; 29 (06) 569-573
- 51 Logan RF, Grainge MJ, Shepherd VC, Armitage NC, Muir KR. ukCAP Trial Group. Aspirin and folic acid for the prevention of recurrent colorectal adenomas. Gastroenterology 2008; 134 (01) 29-38
- 52 Sadeghi S, Bain CJ, Pandeya N, Webb PM, Green AC, Whiteman DC. Australian Cancer Study. Aspirin, nonsteroidal anti-inflammatory drugs, and the risks of cancers of the esophagus. Cancer Epidemiol Biomarkers Prev 2008; 17 (05) 1169-1178
- 53 Gresele P, Momi S, Malvestiti M, Sebastiano M. Platelet-targeted pharmacologic treatments as anti-cancer therapy. Cancer Metastasis Rev 2017; 36 (02) 331-355
- 54 Potts JE, Iliescu CA, Lopez Mattei JC. et al. Percutaneous coronary intervention in cancer patients: a report of the prevalence and outcomes in the United States. Eur Heart J 2019; 40 (22) 1790-1800
- 55 Lancellotti P, Nkomo VT, Badano LP. et al; European Society of Cardiology Working Groups on Nuclear Cardiology and Cardiac Computed Tomography and Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, Society of Cardiovascular Computed Tomography. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2013; 14 (08) 721-740
- 56 Urban P, Mehran R, Colleran R. et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J 2019; 40 (31) 2632-2653
- 57 Ko DT, Yun L, Wijeysundera HC. et al. Incidence, predictors, and prognostic implications of hospitalization for late bleeding after percutaneous coronary intervention for patients older than 65 years. Circ Cardiovasc Interv 2010; 3 (02) 140-147
- 58 Kamphuisen PW, Beyer-Westendorf J. Bleeding complications during anticoagulant treatment in patients with cancer. Thromb Res 2014; 133 (Suppl. 02) S49-S55
- 59 Raposeiras-Roubín S, Faxén J, Íñiguez-Romo A. et al. Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: the BleeMACS score. Int J Cardiol 2018; 254: 10-15
- 60 Mehran R, Rao SV, Bhatt DL. et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011; 123 (23) 2736-2747
- 61 Gargiulo G, Valgimigli M, Capodanno D, Bittl JA. State of the art: duration of dual antiplatelet therapy after percutaneous coronary intervention and coronary stent implantation - past, present and future perspectives. EuroIntervention 2017; 13 (06) 717-733
- 62 Chin CT, Roe MT, Fox KA. et al; TRILOGY ACS Steering Committee. Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial. Am Heart J 2010; 160 (01) 16.e1-22.e1
- 63 Wiviott SD, Braunwald E, McCabe CH. et al; TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357 (20) 2001-2015
- 64 Rothwell PM, Wilson M, Price JF, Belch JF, Meade TW, Mehta Z. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. Lancet 2012; 379 (9826): 1591-1601
- 65 Serebruany VL, Kim MH, Cabrera-Fuentes HA. et al. Mortality and cancer after 12 versus 30 months dual antiplatelet therapy. The Korean Outcomes Registry Evaluating Antithrombotics (KOREA). Thromb Haemost 2017; 117 (05) 934-939
- 66 Serebruany VL. Platelet inhibition with prasugrel and increased cancer risks: potential causes and implications. Am J Med 2009; 122 (05) 407-408
- 67 Bonaca MP, Bhatt DL, Cohen M. et al; PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015; 372 (19) 1791-1800
- 68 Mauri L, Kereiakes DJ, Yeh RW. et al; DAPT Study Investigators. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med 2014; 371 (23) 2155-2166
- 69 Urban P, Meredith IT, Abizaid A. et al; LEADERS FREE Investigators. Polymer-free drug-coated coronary stents in patients at high bleeding risk. N Engl J Med 2015; 373 (21) 2038-2047
- 70 Ariotti S, Adamo M, Costa F. et al; ZEUS Investigators. Is bare-metal stent implantation still justifiable in high bleeding risk patients undergoing percutaneous coronary intervention?: a pre-specified analysis from the ZEUS trial. JACC Cardiovasc Interv 2016; 9 (05) 426-436
- 71 ClinicalTrials.gov. Management of high bleeding risk patients post bioresorbable polymer coated stent implantation with an abbreviated versus prolonged DAPT regimen (MASTER DAPT). ClinicalTrials.gov Identifier: NCT03023020. Accessed December 9, 2020 at: https://www.clinicaltrials.gov/ct2/show/NCT03023020
- 72 Windecker S, Latib A, Kedhi E. et al; ONYX ONE Investigators. Polymer-based or polymer-free stents in patients at high bleeding risk. N Engl J Med 2020; 382 (13) 1208-1218
- 73 Mauri L, Kirtane AJ, Windecker S. et al. Rationale and design of the EVOLVE Short DAPT Study to assess 3-month dual antiplatelet therapy in subjects at high risk for bleeding undergoing percutaneous coronary intervention. Am Heart J 2018; 205: 110-117
- 74 ClinicalTrials.gov. XIENCE 28 USA study. ClinicalTrials.gov Identifier: NCT03815175. Accessed December 9, 2020 at: https://clinicaltrials.gov/ct2/show/NCT03815175
- 75 ClinicalTrials.gov. XIENCE 90: a safety evaluation of 3-month DAPT after XIENCE implantation for HBR patients. ClinicalTrials.gov Identifier: NCT03218787. Accessed December 9, 2020 at: https://clinicaltrials.gov/ct2/show/NCT03218787
- 76 Capodanno D, Morice MC, Angiolillo DJ. et al. Trial design principles for patients at high bleeding risk undergoing PCI: JACC Scientific Expert Panel. J Am Coll Cardiol 2020; 76 (12) 1468-1483
- 77 Varenne O, Cook S, Sideris G. et al; SENIOR investigators. Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial. Lancet 2018; 391 (10115): 41-50
- 78 Kirtane A, Kandzari DE, Mehran R. et al. one month dual antiplatelet therapy in high bleeding risk patients: primary results from the onyx one clear study. J Am Coll Cardiol 2020; 75 (11, Suppl 1): 1097
- 79 Yoshio T, Nishida T, Hayashi Y. et al. Clinical problems with antithrombotic therapy for endoscopic submucosal dissection for gastric neoplasms. World J Gastrointest Endosc 2016; 8 (20) 756-762
- 80 Randel KR, Botteri E, Romstad KMK. et al. Effects of oral anticoagulants and aspirin on performance of fecal immunochemical tests in colorectal cancer screening. Gastroenterology 2019; 156 (06) 1642.e1-1649.e1
- 81 Becker RC, Scheiman J, Dauerman HL. et al; American College of Cardiology and the American College of Gastroenterology. Management of platelet-directed pharmacotherapy in patients with atherosclerotic coronary artery disease undergoing elective endoscopic gastrointestinal procedures. Am J Gastroenterol 2009; 104 (12) 2903-2917
- 82 Fujimoto K, Fujishiro M, Kato M. et al; Japan Gastroenterological Endoscopy Society. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014; 26 (01) 1-14
- 83 Grines CL, Bonow RO, Casey Jr DE. et al; American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, American Dental Association, American College of Physicians. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 2007; 115 (06) 813-818
- 84 Tounou S, Morita Y, Hosono T. Continuous aspirin use does not increase post-endoscopic dissection bleeding risk for gastric neoplasms in patients on antiplatelet therapy. Endosc Int Open 2015; 3 (01) E31-E38
- 85 Rossini R, Tarantini G, Musumeci G. et al; Italian Society of Interventional Cardiology (SICI-GISE), Italian Society for the Study of Haemostasis and Thrombosis (SISET), Italian Society of Anesthesia and Intensive Care Medicine (SIAARTI), Italian Society of Surgery (SIC), Italian Society for Cardiac Surgery (SICCH), Italian Society of Vascular and Endovascular Surgery (SICVE), Italian Society of Urology (SIU), Italian Orthopaedic Society (SIOT), Italian Society of Thoracic Surgeons (SICT), Italian Federation of Scientific Societies of Digestive System Diseases (FISMAD), Italian Society of Digestive Endoscopy (SIED), Italian Association of Hospital Gastroenterology and Digestive Endoscopy (AIGO), Italian Association of Gastroenterology and Digestive Endoscopy (SIGE), Italian Society of Maxillofacial Surgery (SICMF), Italian Society of Reconstructive Plastic Surgery and Aesthetics (SICPRE), Italian Society of Gynecology and Obstetrics (SIGO), Italian Society of Neurosurgery (SINch), Italian Association of Hospital Pulmonologist (AIPO), Italian Society of Periodontology (SIdP), Italian Society of Ophthalmology (SOI), Italian Association of Hospital Otorhinolaryngologist (AOOI), Italian Association of Hospital Surgeons (ACOI), Association of Obstetricians Gynecologists Italian Hospital (AOGOI). A multidisciplinary approach on the perioperative antithrombotic management of patients with coronary stents undergoing surgery: surgery after stenting 2. JACC Cardiovasc Interv 2018; 11 (05) 417-434
- 86 Egholm G, Kristensen SD, Thim T. et al. Risk associated with surgery within 12 months after coronary drug-eluting stent implantation. J Am Coll Cardiol 2016; 68 (24) 2622-2632
- 87 Iliescu CA, Cilingiroglu M, Giza DE. et al. “Bringing on the light” in a complex clinical scenario: optical coherence tomography-guided discontinuation of antiplatelet therapy in cancer patients with coronary artery disease (PROTECT-OCT registry). Am Heart J 2017; 194: 83-91
- 88 Galderisi M, Esposito R, Sorrentino R, Mura L, Santoro C, Tufano A. Atrial fibrillation, cancer and echocardiography. J Cardiovasc Echogr 2020; 30 (Suppl. 01) S33-S37
- 89 Leong DP, Caron F, Hillis C. et al. The risk of atrial fibrillation with ibrutinib use: a systematic review and meta-analysis. Blood 2016; 128 (01) 138-140
- 90 Vranckx P, Valgimigli M, Eckardt L. et al. Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. Lancet 2019; 394 (10206): 1335-1343
- 91 Lopes RD, Heizer G, Aronson R. et al; AUGUSTUS Investigators. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med 2019; 380 (16) 1509-1524
- 92 Cannon CP, Bhatt DL, Oldgren J. et al; RE-DUAL PCI Steering Committee and Investigators. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med 2017; 377 (16) 1513-1524
- 93 Gibson CM, Mehran R, Bode C. et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016; 375 (25) 2423-2434
- 94 Gargiulo G, Goette A, Tijssen J. et al. Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials. Eur Heart J 2019; 40 (46) 3757-3767
- 95 Hindricks G, Potpara T, Dagres N. et al; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 42 (05) 373-498
- 96 Reddy VY, Möbius-Winkler S, Miller MA. et al. Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology). J Am Coll Cardiol 2013; 61 (25) 2551-2556
- 97 Banasiak W, Zymliński R, Undas A. Optimal management of cancer patients with acute coronary syndrome. Pol Arch Intern Med 2018; 128 (04) 244-253