心房顫動 (atrial fibrillation, AF) 是最常見的心律不整，冠狀動脈疾病 (coronary artery disease, CAD) 則是目前最常見的心血管疾病，大約有5 ~ 15% 的AF 患者在 其生命中的某個時間點，需要接受經皮冠狀動脈介入治療及支架置入術，且將接受 aspirin 並用clopidogrel 或 ticagrelor 及口服抗凝劑 (oral anticoagulant, OAC) 的三合 一抗血栓治療 (triple antithrombotic therapy, TAT)。抗血栓治療需要考慮出血、中風和 支架內形成血栓，造成的急性冠心症三者間的風險平衡。OAC 與抗血小板藥物共同 治療，特別是TAT，增加了重大出血的絕對風險。統合分析結合WOEST、PIONEER AF-PCI、RE-DUAL PCI 顯示二合一抗血栓治療 (dual antithrombotic therapy, DAT) 即 OAC 再加一個抗血小板藥，不會比 TAT 發生更多血栓栓塞的事件，但出血的機會卻可 以減少一半。目前 2 個正在進行的 non-vitamin K antagonist oral anticoagulant (NOAC) in AF trials，將進一步提供抗血栓治療方案的正確選擇和 TAT 治療適當期間的訊息。

ABSTRACT

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and coronary artery disease (CAD) is the most common cardiovascular disease. Approximately 5 to 15% of patients with AF require percutaneous coronary intervention and stenting during their lifetime, and will receive triple therapy with aspirin, clopidogrel or ticagrelor, and oral anticoagulant (OAC). Antithrombotic therapy requires careful consideration of balancing bleeding risk, stroke risk, and stent thrombosis leading to subsequent acute coronary syndrome. OAC and antiplatelet combination therapy, especially triple antithrombotic therapy (TAT), increases the absolute risk of major bleeding. A meta-analysis combining WOEST, PIONEER AF-PCI, and RE-DUAL PCI showed that dual antithrombotic therapy (OAC with one antiplatelet) did not cause more thromboembolic events than TAT, but the risk of bleeding was indeed reduced by half. Further information on the choice of antithrombotic therapy and appropriate TAT duration will be provided in two ongoing non-vitamin K antagonist oral anticoagulant (NOAC) in AF trials.