Częstość występowania migotania przedsionków (AF) w populacji osób powyżej 20 roku życia wynosi około 3%, ale odsetki te w procesie starzenia, u chorych w nadciśnieniem tętniczym, chorobą niedokrwienną serca, niewydolnością krążenia , cukrzycą, wadami zastawkowymi, otyłością i przewlekłą niewydolnością nerek – znacznie wzrastająTriple antithrombotic therapy with warfin plus two antiplatelet agents (DAP) is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with risk of fatal and nonfatal bleeding. Furthermore, shortening the course of triple therapy does not substantially reduce the bleeding risk. Thus, although triple therapy may prevent ischemic events better, it also has the potential to cause considerable harm in many patients. Two new promising therapeutic strategies have emerged to reduce risk of bleeding among patients whom both oral anticoagulation and antiplateled therapy are indicated. The first is the use of non-vitamin K-antagonist oral anticoagulants — rivaroxaban and dabigatran. The second is omission of aspirin or clopidogrel from standard regimen and the use of a single P2Y12 inhibitors (SAP). In this article the results from four major trials of compared triple therapy (TT) versus dual therapy (DT) were presented. In two trials (WOEST and ISAR-REACT) patients with AF and stent implantation who were randomly assigned to receive warfin + DAPT (aspirin and clopidogrel) andpatients who were assigned to dual therapy were compared; warfin and single antiplatelet agent — clopidogrel or aspirin. Two new trials, PIONEER and RE-DUAL compared patients who were randomly assigned to receive non-vitamin K antagonist rivaroxaban and clopidogrel versus standard triple therapy (PIONEER) and dabigatran with clopidogrel versus standard triple therapy (RE-DUAL). In all four studies bleeding complications were significantly lower for patients treated with DT versus TT. Additionally, we presented an informal meta-analysis of the results of these four large trials, performed with the use of the DerSimonian and Laird method for random effects. The odds ratio of major and minor bleeding with dual therapy are half the odds with triple therapy 0.51 (0.37–0.69). The meta-analysis suggests that the risk of major adverse cardiovascular events is not higher with dual therapy than in triple therapy 0.89 (0.65–1.22). No single trial has been adequately powered to completely rule out an increase in ischemic events with dual therapy versus tripletherapy. The aggregate evidence suggests that the net clinical benefit of dual therapy should give cardiologists confidence to drop aspirin or clopidogrel when they are using a contemporary strategy in patients with AF after stent implantation
