DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION PRESENTING WITH STSEGMENT ELEVATION MYOCARDIAL INFARCTION
Abstract:
Ischemic heart disease with all of its forms is the most common cause of death worldwide.
The pathophysiological substrate of coronary artery disease is atherosclerosis. Atherosclerosis was
previously seen as a disease based on cholesterol storage in blood vessel, but now it is recognized as
a complex process that involved inflammatory cells and a complex process that involves the arterial
wall and its interaction with risk factors. Acute myocardial infarction remains the main cause of death
in women. The complication of AMI with a cardiogenic shock increases the mortality risk even more.
In the association between atrial fibrillation and acute coronary syndromes there is a major concern
of the bleeding risk regarding the necessity of anticoagulant treatment and dual anti-platelet therapy.
Although previously avoided, in the last years, direct oral anticoagulants (or non-vitamin K
antagonists) began to be used in triple therapy with good results regarding bleeding and ischemic
events. The case below presents a 77-year old woman with ST-elevation acute myocardial infarction,
complicated with cardiogenic shock, with previously known atrial fibrillation, treated with
dabigatran, clopidogrel and aspirin as triple antithrombotic therapy
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