Triple Antithrombotic Therapy – Always One Too Many? –

Hidehira Fukaya; Junya Ako

doi:10.1253/circj.cj-15-1360

January 1, 2016Circulation JournalOpen Access

Triple Antithrombotic Therapy – Always One Too Many? –

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Why the study?

Does triple therapy compared to dual antiplatelet therapy improve thromboembolic outcomes or increase bleeding in AF patients undergoing PCI?

Structured PICO

Does triple therapy compared to dual antiplatelet therapy improve thromboembolic outcomes or increase bleeding in AF patients undergoing PCI?

P

Population

585 atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) from a prospective multicenter registry, stratified by CHA2DS2-VASc score (26.8% score=1, 73.2% score ≥2).

I

Intervention

Triple therapy (TT: dual antiplatelet therapy plus anticoagulation)

C

Comparator

Dual antiplatelet therapy (DAPT)

O

Outcome

Thromboembolic events and bleeding complications at 1-year follow-uphard clinical

Limitations

Nonrandomized observational study carries a risk for bias
A regimen of an oral anticoagulant and a single P2Y12 inhibitor was not included
Direct oral anticoagulants (DOAC) were not used as an anticoagulant in this study

Implication

Individualized risk assessment using the CHA2DS2-VASc score is essential to balance the thromboembolic benefits and bleeding risks of triple antithrombotic therapy in AF patients undergoing PCI.