How would you approach the duration and initiation of DAPT or SAPT for SCAD in a patient with Atrial Fibrillation on therapeutic anticoagulation?

Spontaneous coronary artery dissection is a rare cause for an acute coronary syndrome afflicting predominantly females in the 30-55 year old age group and typically occurs in the absence of underlying atherosclerosis. This is a completely different mechanism for an acute infarction than that caused by an underlying atherosclerotic plaque, plaque rupture, and thrombus formation, which is typically seen in older individuals. "Dissection" in this condition is also misleading. SCAD infrequently occurs because of a tear of the intimal layer with blood collection in the media. The most prevalent mechanism is a rupture of the vaso-vasorum, forming a hematoma in the media layer, which then compresses the arterial lumen. Although the mechanisms for ...