New Era of Antithrombotic Therapy

Recent large-scale clinical trials and their meta-analysis revealed the efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) in primary and secondary prevention of stroke/systemic thromboembolism in non-valvular atrial fibrillation (NVAF) and venous thromboembolism in comparison with warfarin. Based on these evidences, recent guidelines recommend the use of NOAC in preference to warfarin, especially in stroke prevention in NVAF. It still remains to be elucidated, however, if the efficacy and safety profiles of NOAC in the real world where patients with a variety of clinical profiles are treated are similar to those shown by the clinical trials. It also should be determined how the anticoagulant therapy with NOAC to be managed in specific but common clinical situations such as cardioversion of AF, catheter ablation of AF, acute coronary syndrome and percutaneous coronary intervention (PCI). On the other hand, the antiplatelet therapy in coronary artery disease and the use of anticoagulant combined with antiplatelet have been reconsidered. Guidelines recommend dual antiplatelet therapy (DAPT) for at least 12 months after PCI with drug-eluting stent (DES), but recent studies have suggested the use of DAPT for a shorter period. A recent DAPT study demonstrated that DAPT beyond 1 year after DES placement, as compared with aspirin alone, significantly reduces the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events while being associated with an increased risk of bleeding. The management of anticoagulant in AF patients undergoing PCI including the duration of combined therapy and selection of anticoagulant remains to be determined. In this symposium, we would discuss how we should manage the patients requiring anticoagulant and/or antiplatelet in the real-world situations. We hope this symposium would be helpful in practicing antithrombotic therapy effectively and safely.