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VIDEO: Bleeding risks, lack of data present challenges in managing AF, ACS
ORLANDO, Fla. — L. Kristin Newby, MD, MHS, FAHA, of the cardiology department at Duke University Medical Center, discusses the management of patients with atrial fibrillation and ACS, outlining therapeutic approaches and highlighting key data.
“This is a really challenging group,” she said. “Anywhere from 5% to 20% of patients who have an [ACS] have, or will develop, [AF].”
Newby discusses pharmacotherapy options in the antithrombotic realm to treat ACS, as well as in the anticoagulation arena to treat AF.
“Preventing a recurrent ischemic event or stent thrombosis with dual antiplatelet therapy or preventing a stroke with anticoagulant therapy both increase an individual’s bleeding risk,” she said. “There’s no way that we can prevent one and not affect the other.”
Newby notes a lack of randomized clinical trial data on balancing risks, and she said existing data are on older drugs. She points to a helpful European consensus document and outlines the recommendations.
“The biggest challenge right now, and where most of the interest lies, is what we do with the new oral anticoagulants. We really don’t have enough evidence to practice in that space,” she said.
Newby cites three ongoing trials — PIONEER, RE-DUAL and AUGUSTUS — could “generate the evidence that we really need to move treating ACS patients with [AF] into the modern era.”