Related Experiment Video
Updated: Mar 8, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Antiplatelet therapies in patients with an indication for anticoagulation
Insights
Triple therapy combining anticoagulants and antiplatelets is vital for high-risk patients but increases bleeding. Physician practices vary widely due to limited evidence and guidelines for this complex treatment.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Triple therapy is crucial for patients with high risk of arterial (in-stent) and venous thrombosis, or atrial fibrillation.
- This patient group is often frail with comorbidities and advanced age, increasing bleeding risk.
- Limited randomized trials exist for various drug combinations, leading to common off-label use.
Purpose of the Study:
- To investigate physician practices regarding triple anticoagulant/antiplatelet therapy.
- To understand the variability in therapeutic choices and treatment durations.
- To highlight the need for clearer guidelines in managing complex thrombotic and bleeding risks.
Main Methods:
- A survey was conducted among physicians treating patients requiring anticoagulation and with a history of stenting.
- Physicians' choices of anticoagulant/antiplatelet combinations and treatment durations were assessed.
- Data on the use of novel anticoagulants versus vitamin K antagonists were collected.
Main Results:
- Physician opinions on recommended triple therapy were highly divided.
- Novel anticoagulants were used as frequently as vitamin K antagonists.
- Treatment durations for triple therapy showed significant variability among practitioners.
Conclusions:
- Clinical decisions for triple therapy are individualized, balancing ischemic and bleeding risks.
- Lack of specific randomized trials and guidelines contributes to therapeutic variability.
- Further research is needed to establish evidence-based recommendations for optimal triple therapy regimens.
Abstract:
Triple anticoagulant therapy is necessary in patients who are at increased risk for both arterial (in stent) and venous thrombosis, or have atrial fibrillation. Triple therapy however also poses a very high risk for bleeding events, particularly because this subset of patients is particularly frail due to the high incidence of comorbidities and advanced age. Very little randomized studies have tested the impact of the many possible combinations of anticoagulant/antiaggregant drugs, and surveys among practicing physicians show that the use of off-label therapies is very common. In a recent survey from our group, we observed that physicians are very divided in terms of what therapy should be recommended to patients with indication to anticoagulation and with a history of stenting. The use of novel anticoagulants was as frequent as that of vitamin K antagonists, and the duration of triple therapy was very variable.While these data probably show that decisions are usually taken on an individual basis, considering the patient's risk of ischemia and hemorrhagic events, much of this variability probably depends on the fact that, failing randomized trials, guidelines in this area are relatively less specific than in other ones.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care