December 2, 2013European Heart Journal32 citationsOpen Access
Triple antithrombotic therapy in cardiac patients: more questions than answers
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Structured PICO
What are the approaches to reduce the risk of bleeding without increasing ischaemic events in cardiac patients requiring combined antithrombotic therapy?
P
Population
Cardiac patients requiring combined antithrombotic therapy (anticoagulant and inhibition of platelet function), frequently with atrial fibrillation (AF) in combination with drug-eluting stent implantation and/or acute coronary syndrome (ACS)
I
Intervention
Combined antithrombotic therapy (anticoagulant and anti-platelet therapy)
O
Outcome
Bleeding ratessafety
This review highlights the increased bleeding risk associated with triple antithrombotic therapy in patients with AF and ACS/PCI and discusses approaches to mitigate this risk.
Abstract
Many cardiac patients require combined antithrombotic therapy consisting of an anticoagulant and inhibition of platelet function. The most frequent indications are atrial fibrillation (AF) in combination with drug-eluting stent implantation and/or the presence of an acute coronary syndrome (ACS). Currently, the optimal combination of anticoagulants and anti-platelet therapy is unknown, but it is well established that the combination of regular doses and regimens as prescribed in AF or after ACS results in increased bleeding rates. In this review, we discuss the current literature and describe approaches to reduce the risk of bleeding hoping not to increase the rate of ischaemic events.