Dual Antithrombotic Plus Adjunctive Antiinflammatory Therapy to Improve Cardiovascular Outcome in Atrial Fibrillation Patients with Concurrent Acute Coronary Syndrome: A Triple-Pathway Strategy

Publication date: Available online 1 March 2018
Source:Medical Hypotheses
Author(s): Gerald Chi, Adeel Jamil, Miroslav Radulovic, Umer Jamil, Muhammad A. Balouch, Jolanta Marszalek, Zahra Karimi, Seyedmahdi Pahlavani, Mehrian Jafarizade, Husnain Shaukat, Sunny Kumar, Arzu Kalayci
The concurrence of atrial fibrillation and acute coronary syndrome poses a conundrum in the antithrombotic management as intensification of anticoagulation or antiplatelet therapy inevitably comes at the price of an increased bleeding risk. Various antithrombotic combinations have been attempted to prevent the recurrent cardiovascular events, however, there has been limited success in effective risk reduction for this high risk population. Given the overarching effect of interleukin 1β-driven inflammation on the arrhythmogenesis, thrombogenesis, and hypercoagulability, we hypothesize that the triple-pathway strategy (i.e., incorporating antiinflammatory therapy into anticoagulant and antiplatelet therapy) would grant incremental cardiovascular benefits for atrial fibrillation patients with coexisting acute coronary syndrome and stent placement.



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