Concomitant antiplatelet and anticoagulation therapy: indications, controversies and practical advice

The use of combination antiplatelet and anticoagulant therapy is commonly encountered in clinical practice and is often a source of clinical controversy in regards to the efficacy versus the safety of this regimen. The benefit of combination therapy relates to the probable additive effect of suppressing both platelet and coagulation factor activities. The risk of dual therapy is the potential for increased hemorrhagic events which may outweigh the clinical benefit. This review will focus on the clinical evidence that has demonstrated greater efficacy with combination therapy over either antiplatelet or anticoagulant therapy alone. Clinicians should consider the importance of documentation of combination therapy use in their patients in an effort to target those patients with the greatest benefit, and to avoid unnecessary complications.