Fast Five Quiz: Atrial Fibrillation and Acute Coronary Syndrome

Sandeep K. Goyal, MD


September 17, 2020

In patients with ACS and AF, careful consideration is needed when selecting antithrombotic therapy. A NOAC is preferred over a vitamin K antagonist for eligible patients with ACS and AF (ie, in the absence of a mechanical heart valve, moderate to severe mitral stenosis, and severe renal insufficiency), due to its superior safety and efficacy profile.

Dual antiplatelet therapy has not been shown to provide adequate protection against strokes related to AF.

Patients with ACS and concomitant AF may undergo percutaneous coronary intervention when appropriate. However, major bleeding after percutaneous coronary intervention has been shown to be associated with increased mortality, so bleeding risk should be kept to a minimum.

According to the Chronic Coronary Syndromes Clinical Practice Guidelines of the European Society of Cardiology, long-term oral anticoagulant therapy (either with a NOAC 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.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.