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Antithrombotic Therapies for Acute Coronary Syndrome and Atrial Fibrillation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 December 2025 | Viewed by 268

Special Issue Editor


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Guest Editor
Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
Interests: haemostasis assays; thrombophilia; direct oral anticoagulants

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) and acute coronary syndrome (ACS) significantly increase the risk of thromboembolic events. Treatment of these conditions has evolved from vitamin K antagonists and aspirin to novel antithrombotic therapies, reflecting advances in our understanding of the pathophysiology of these conditions. This Special Issue looks at the latest developments in antithrombotic therapy for AF and ACS, highlighting innovative approaches to prevention and treatment as well as the challenges in clinical practice. We are soliciting original research articles, reviews and clinical trials that address the latest advances in antithrombotic therapies for patients with AF and ACS. Our aim is to highlight innovative strategies, evaluate current treatment protocols and identify gaps in knowledge that require further investigation. We encourage submissions that address the efficacy and safety of novel anticoagulants, patient-centred approaches to therapy selection, and the integration of technology in the monitoring and treatment of these conditions.

Dr. Mojca Božič Mijovski
Guest Editor

Manuscript Submission Information

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Keywords

  • atrial fibrillation
  • acute coronary syndrome
  • antiplatelet agents
  • anticoagulants
  • thrombolysis
  • direct coagulation factor inhibitors
  • medical laboratory technology

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Published Papers (1 paper)

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Review

11 pages, 486 KB  
Review
Antiplatelet Therapy in Atrial Fibrillation Patients on Direct Oral Anticoagulants Undergoing Percutaneous Coronary Intervention: Which and How
by Luca Martini, Matteo Lisi, Graziella Pompei, Manfredi Arioti, Francesco Bendandi, Michael Y. Henein, Matteo Cameli and Andrea Rubboli
J. Clin. Med. 2025, 14(17), 6331; https://doi.org/10.3390/jcm14176331 (registering DOI) - 8 Sep 2025
Abstract
In patients on oral anticoagulation (OAC), typically for atrial fibrillation (AF), undergoing percutaneous coronary intervention (PCI), the antiplatelet drugs to be added to direct oral anticoagulant (DOAC) are aspirin and clopidogrel during the initial, short (up to one week) period of triple antithrombotic [...] Read more.
In patients on oral anticoagulation (OAC), typically for atrial fibrillation (AF), undergoing percutaneous coronary intervention (PCI), the antiplatelet drugs to be added to direct oral anticoagulant (DOAC) are aspirin and clopidogrel during the initial, short (up to one week) period of triple antithrombotic therapy (TAT), and clopidogrel alone during the subsequent 6- to 12-month period of double antithrombotic therapy (DAT). Both direct and indirect data support the recommendation to avoid the more potent P2Y12 inhibitors—ticagrelor and prasugrel—as part of TAT, owing to the increased risk of bleeding. There is less and inconclusive data available regarding the safety and efficacy of DAT when ticagrelor or prasugrel are used instead of clopidogrel. Also, there is very limited evidence for the use of aspirin instead of clopidogrel in a DAT regimen. While acknowledging the safety and effectiveness of the recommended strategies above, it would, nonetheless, be valuable to have alternative options in the choice of antiplatelet agents. In case of very high thrombotic risk, especially when stents are positioned in potentially risky sites (such as the left main or last remaining vessel) a more potent P2Y12 inhibitor than clopidogrel may be warranted. Moreover, non-responsiveness to, or pharmacological interactions of, clopidogrel may hamper its efficacy. In this review, we aim at presenting and discussing the evidence supporting the current recommendations for the use of the various antiplatelet agents in AF patients on OAC undergoing PCI, as well as at giving a glimpse at future perspectives. Full article
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