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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Triple Antithrombotic Therapy (Triple Therapy) After Percutaneous Coronary Intervention in Chronic Anticoagulation: A

Ali Hussain1, Amjad Minhas2, Usman Sarwar3,4

  • 1Internal Medicine, Sentara Albemarle Medical Center, Elizabeth City, USA.

Cureus
|March 9, 2022
PubMed

Insights

Choosing anticoagulation for atrial fibrillation and coronary artery disease patients is complex. Triple therapy increases bleeding and mortality risk compared to dual therapy with an anticoagulant and P2Y12 inhibitor.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Managing patients with both atrial fibrillation and coronary artery disease requires careful consideration of antithrombotic therapy.
  • Treatment strategies have evolved from warfarin to dual antiplatelet therapy.

Purpose of the Study:

  • To review the evolution of anticoagulation strategies for patients with atrial fibrillation and coronary artery disease.
  • To compare the risks and benefits of different antithrombotic regimens.

Main Methods:

  • Literature review of historical and current treatment guidelines.
  • Analysis of comparative effectiveness and safety data for various antithrombotic combinations.

Main Results:

  • Warfarin was an early option for preventing stent thrombosis.
  • Dual antiplatelet therapy is now the standard recommendation.
  • Triple therapy (aspirin, P2Y12 inhibitor, oral anticoagulation) shows increased bleeding and mortality.

Conclusions:

  • Triple therapy in this patient population is associated with significant risks.
  • A combination of an anticoagulant and a P2Y12 inhibitor may offer a safer alternative.

Keywords:
atrial fibrillation and pcicad: coronary artery diseasedual-antiplatelet therapy (dapt)non-valvular atrial fibrillationtherapeutic anticoagulation

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