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Triple antithrombotic therapy in patients with atrial fibrillation undergoing PCI: current evidence and practice

Alice Clarke1, Abdalla Ibrahim2, Thomas J Kiernan3

  • 1a University of Limerick, Graduate Entry Medical School (GEMS) , Castletroy , Ireland.

Expert Review of Cardiovascular Therapy
|September 15, 2018
PubMed

Insights

Triple therapy (TT) reduces ischemic events but increases bleeding risk in patients with atrial fibrillation undergoing stenting. Optimal duration and antithrombotic choices require further research to balance risks and benefits.

Area of Science:

  • Cardiology
  • Pharmacology
  • Thrombosis Research

Background:

  • Patients with atrial fibrillation requiring oral anticoagulation and percutaneous coronary intervention with stent insertion are typically prescribed triple therapy (TT), a combination of aspirin and a P2Y12 receptor antagonist.
  • While TT effectively reduces ischemic events like stroke and stent thrombosis, it significantly elevates the risk of bleeding complications.

Purpose of the Study:

  • To review current evidence on the efficacy and safety of triple therapy (TT) in patients with atrial fibrillation undergoing percutaneous coronary intervention.
  • To explore optimal duration, dosage, and antithrombotic agent selection for TT, considering factors like stent type and individual patient risk.

Main Methods:

  • Systematic review of clinical trials evaluating triple therapy (TT) in the specified patient population.
  • Analysis of data concerning thromboembolic events, bleeding risks, and comparative effectiveness against alternative antithrombotic strategies.

Main Results:

  • Triple therapy (TT) demonstrates efficacy in reducing ischemic risks.
  • However, trials have not established TT's superiority over dual therapy (single antiplatelet plus anticoagulant) and consistently show an increased bleeding risk with TT.
  • Optimal duration and specific antithrombotic combinations for TT remain undetermined.

Conclusions:

  • Further research is essential to balance the thromboembolic and bleeding endpoints associated with triple therapy (TT).
  • Identifying optimal TT duration, antithrombotic choices, and incorporating individualized patient risk stratification are crucial for maximizing benefits and minimizing harm.
Abstract

Keywords:
Atrial fibrillationantithrombotic therapybleeding riskdual therapyoral anticoagulationpercutaneous coronary interventionstent thrombosisstroketriple therapy

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