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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Published on: February 28, 2012

Triple versus double antithrombotic therapy after PCI in atrial arrhythmia: a real-world comparative analysis based

Khaled Elnaggar1, Mohammad Hamza2, Saif Ali Malik3

  • 1Department of Medicine, Detroit Medical Center Huron Valley Sinai, Detroit, MI, USA.

Future Cardiology
|August 20, 2026
PubMed

Insights

Triple therapy (TT) after percutaneous coronary intervention (PCI) in atrial arrhythmia patients showed worse outcomes than double therapy (DT). This study highlights the need for randomized trials to confirm optimal antithrombotic strategies for coronary artery disease (CAD).

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Optimal antithrombotic regimen post-percutaneous coronary intervention (PCI) for atrial arrhythmias is unclear.
  • Balancing double therapy (DT) versus triple therapy (TT) poses a clinical challenge.
  • Limited comparative data exists across coronary artery disease (CAD) phenotypes.

Purpose of the Study:

  • To compare the clinical outcomes of triple therapy (TT) versus double therapy (DT) in patients with atrial arrhythmias undergoing PCI for CAD.
  • To analyze outcomes based on different CAD phenotypes.

Main Methods:

  • Retrospective cohort study using the TriNetX database.
  • Included adults with atrial fibrillation/flutter undergoing PCI for CAD.
  • Propensity score matching (1:1) for TT and DT groups.

Main Results:

  • Triple therapy (TT) was associated with higher composite outcomes at 1, 6, and 12 months compared to double therapy (DT).
  • TT showed increased risks of recurrent myocardial infarction (MI), hospitalization/ER visits, and blood transfusion.
  • Subgroup analysis revealed similar outcomes in STEMI, but higher hospitalization/ER visits with TT in NSTEMI/UA.

Conclusions:

  • Triple therapy (TT) is linked to worse clinical outcomes than double therapy (DT) in CAD patients undergoing PCI.
  • Findings suggest a need for prospective randomized trials to validate these results.
  • This research informs antithrombotic strategy decisions in complex cardiovascular patients.
Abstract

Keywords:
Atrial fibrillationanticoagulationdouble therapypercutaneous coronary interventiontriple therapy

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