Fast Five Quiz: Atrial Fibrillation and Acute Coronary Syndrome

Sandeep K. Goyal, MD


March 10, 2022

No single antithrombotic treatment regimen is appropriate for all patients with AF and ACS. Available data promote the use of full-dose direct oral anticoagulants (dabigatran 150 mg twice daily or apixaban 5 mg twice daily) or rivaroxaban 15 mg once daily in patients with AF and ACS or percutaneous coronary intervention. For many patients, the use of a direct oral anticoagulant plus a P2Y12 inhibitor early after ACS and/or percutaneous coronary intervention would be most advantageous; in patients who are at high thrombotic risk, a longer course of triple therapy is appropriate.

The use of dual antiplatelet therapy alone does not sufficiently protect patients against stroke; oral anticoagulant monotherapy, either a direct oral anticoagulant or vitamin K antagonist, does not protect patients against new coronary events.

According to the Chronic Coronary Syndromes Clinical Practice Guidelines of the European Society of Cardiology, long-term oral anticoagulant therapy (either with a non–vitamin K antagonist or a vitamin K antagonist) is recommended for patients with AF and a CHA2DS2-VASc score of at least 2 in men and at least 3 in women (CHA2DS2-VASc: Cardiac failure, Hypertension, Age ≥ 75 [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65-74, Sex [female]). European Society of Cardiology guidelines also suggest considering long-term oral anticoagulant therapy in patients with AF and a CHA2DS2-VASc score of 1 in men and 2 in women.

Learn more about the prevention of thrombotic events in patients with ACS.


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