Andrea Rubboli - Böcker

The management of patients committed to long-term oral anticoagulation, such as those with atrial fibrillation at moderate to high risk of stroke, mechanical heart valves, and previous arterial/venous thromboembolism, who are submitted to percutaneous coronary intervention (PCI) has become an issue of increasing importance in the last years. Guidelines/expert consensus papers addressing the complex management of this population, which is estimated to represent about 5 to 10% of all patients referred for PCI, have been recently made available. As underlined in the most recent guidelines for the management of atrial fibrillation issued by the European Society of Cardiology (ESC) however, "guidelines are no substitutes for textbooks". This pocketbook addresses the key management points and summarises the properties of the stents and the clinical pharmacology of the antithrombotic agents to be used in these patients. It will be a useful guide for clinical and interventional cardiologists, internists, surgeons, primary care doctors, and other physicians who care for these patients.

This book considers paradigmatic clinical cases in order to cast light on key issues relating to elective or emergency stent implantation and the use of oral anticoagulation (OAC) in patients with atrial fibrillation. The topics addressed include the optimal periprocedural antithrombotic treatment (uninterrupted vs interrupted OAC, intraprocedural use of heparin and glycoprotein IIb/IIIa inhibitors, etc.), the most appropriate type of stent (bare metal vs drug eluting vs “bioactive”), the optimal regimen (e.g., triple therapy of OAC, aspirin, and clopidogrel vs the combination of OAC and a single antiplatelet agent), and the most suitable duration of the antithrombotic treatment prescribed at discharge (1 vs 6–12 months).The case-based management recommendations will be of wide practical value in the current health care context, where percutaneous coronary intervention is available even to patients with relevant co-morbidities, such as those warranting long-term OAC, and the indications for OAC are much broader than in the past. The book will appeal especially to clinical and interventional cardiologists, internal medicine specialists, hematologists, and family physicians and will also be of interest to cardiology and internal medicine residents and fellows.