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[Anticoagulants and dual antiplatelet therapy combined, a challenge to our intelligence]

João Morais1

  • 1Serviço de Cardiologia, Centro Hospitalar Leiria-Pombal, Leiria, Portugal. oaomorais@hsaleiria.min-saude.pt

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|May 1, 2012
PubMed

Insights

Managing dual antiplatelet therapy with anticoagulation in acute coronary syndromes is challenging due to limited evidence. This review examines triple therapy risks and benefits, including new anticoagulant data.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Context:

  • Acute coronary syndromes (ACS) management frequently involves dual antiplatelet therapy (DAPT), particularly with drug-eluting stents.
  • A significant patient subset (10%) with ACS also has or will develop atrial fibrillation, necessitating anticoagulation.
  • The combination of DAPT and anticoagulation presents complex clinical decisions lacking robust evidence and guidelines.

Purpose:

  • To discuss the benefits and risks associated with triple therapy (DAPT plus anticoagulation) in ACS patients.
  • To review available clinical evidence and registry data on combined antiplatelet and anticoagulant therapies.
  • To present findings from Phase II and III studies of novel oral anticoagulants (NOACs) used with DAPT.

Summary:

  • Evidence for triple therapy is scarce, primarily derived from Phase II/III NOAC studies (dabigatran, apixaban, darexaban, rivaroxaban).
  • The ATLAS-ACS 2 TIMI 51 trial, using rivaroxaban, showed positive results, representing key Phase III data.
  • Recommendations from the European Society of Cardiology's Working Group on Thrombosis are also discussed.

Impact:

  • Highlights the critical need for more clinical trials to support evidence-based guidelines for triple therapy in ACS.
  • Informs clinical decision-making regarding the use of novel anticoagulants in combination with DAPT for ACS patients.
  • Provides a concise overview of current evidence and expert recommendations for managing complex thrombotic risk in ACS.

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