Published in:
01-09-2010 | Review article
‘Ins’ and ‘outs’ of triple therapy
Optimal antiplatelet therapy in patients on chronic oral anticoagulation who need coronary stenting
Authors:
W. Dewilde, N. Breet, J. J. Koolen, J. M. Ten Berg
Published in:
Netherlands Heart Journal
|
Issue 9/2010
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Extract
Chronic oral anticoagulant treatment is necessary in patients with mechanical heart valves and in patients with atrial fibrillation and CHADS 2 score >1, with deep venous thrombosis and pulmonary embolism.
1,2 Many of these patients also have ischaemic heart disease. When these patients have to undergo percutaneous coronary intervention (PCI) with stenting, there is also an indication for treatment with aspirin and clopidogrel.
3 The number of these patients keeps on increasing due to a population that is getting older while life expectancy is increasing. However, triple therapy is known to increase the risk of bleeding complications.
1,4,5 We also know that dual antiplatelet treatment and oral anticoagulant treatment are each associated with a nearly 15% risk of major or minor bleeding per year.
6 It is still unknown what the best antithrombotic treatment is, when considering both thrombotic (e.g. stent thrombosis) and bleeding complications. Unfortunately, no prospective (randomised) data are available to solve this issue. …