How manage a patient with coronary disease in atrial fibrillation?

Ischemic heart disease (IHD) and atrial fibrillation (AF) are two very common conditions, particularly in older patients. Thus, patients with atrial fibrillation present more frequently IHD than those in sinus rhythm with a prevalence of 36 to 86%, and patients with ischemic heart disease are more at risk for presenting a passage in atrial fibrillation. In acute coronary syndrome, a great number of patients have atrial fibrillation or present AF as a complication and have a poor prognosis in the short and long term. As a consequence, patients with atrial fibrillation and coronary artery disease represent a therapeutic challenge because of the diverse antithrombotic therapies: treatment of AF must include, depending on the embolic risk, anticoagulation, while in ischemic heart disease antiplatelet therapy must be discussed. Current recommendations extrapolate data from studies on the dosage of each condition Concomitant use of antiplatelet agents and anticoagulants increases the risk of bleeding. Moreover, according to the management period (acute coronary syndromes, angioplasty, stable, patient) of these patients, antithrombotic strategy is specific: the treatment and especially it's duration must be adapted to the bleeding risk. (C) 2016 Elsevier Masson SAS. All rights reserved.