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Thrombolysis Decision on DOAC — EECC MCQ

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HardArrhythmia & ElectrophysiologyThrombolysis Decision on DOACEECC

A patient taking rivaroxaban for AF presents with high-risk NSTE-ACS and is proceeding to urgent PCI. Which antithrombotic principle is most appropriate?

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Correct answer: B — Use PCI anticoagulation and minimise triple therapy

A DOAC dose taken for AF is not a substitute for procedural anticoagulation during PCI. The interventional team should use an appropriate parenteral agent and construct the shortest justified period of triple therapy, followed by a DOAC plus a single antiplatelet, usually clopidogrel. Timing, access site and renal function influence bleeding risk. Prolonged unselected triple therapy is harmful, while withholding all treatment in high-risk ACS can also be dangerous. Fibrinolysis has no routine role in NSTE-ACS.

Reference: 2023 ESC Guidelines for acute coronary syndromes. https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/acute-coronary-syndromes/