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Triple Therapy: When, if Ever?

Nino Mihatov1, Eric A Secemsky1, Sammy Elmariah2

  • 1Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 8-800, Boston, MA, 02114, USA.

Current Treatment Options in Cardiovascular Medicine
|July 4, 2018
PubMed
Summary
This summary is machine-generated.

For patients needing both anticoagulation and stenting, shorter durations of triple therapy (dual antiplatelet therapy and oral anticoagulation) followed by dual therapy with oral anticoagulation and a P2Y12 inhibitor appear safe and effective.

Keywords:
AnticoagulationCoronary artery diseasePercutaneous coronary interventionTriple therapy

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Over 9% of patients undergoing percutaneous coronary intervention (PCI) require long-term oral anticoagulation (OAC).
  • Optimal antithrombotic strategies for these high-risk patients remain unclear.
  • Dual antiplatelet therapy (DAPT) excels at preventing stent-related events, while OAC is superior for atrial fibrillation thromboembolism prevention.

Purpose of the Study:

  • To review current evidence on the safety and efficacy of dual therapy (OAC + P2Y12 inhibitor) versus triple therapy (DAPT + OAC) in stented patients requiring long-term anticoagulation.
  • To evaluate strategies involving shorter durations of triple therapy followed by dual therapy.

Main Methods:

  • Review of numerous studies comparing different antithrombotic regimens.
  • Analysis of data on stent-related events, thromboembolism, and bleeding risks.
  • Focus on recent findings regarding abbreviated triple therapy durations.

Main Results:

  • Triple therapy significantly increases bleeding risk (up to threefold) compared to warfarin monotherapy.
  • Shorter durations of triple therapy followed by dual therapy (OAC + P2Y12 inhibitor) have shown promising safety profiles.
  • Evidence supports the efficacy of OAC in preventing thromboembolism in atrial fibrillation patients.

Conclusions:

  • Dual therapy with OAC and a P2Y12 inhibitor offers a potentially safer alternative to prolonged triple therapy.
  • Optimizing antithrombotic strategies involves balancing the prevention of thrombotic events with minimizing bleeding complications.
  • Further research is needed to establish definitive guidelines for managing these complex patients.