Abstract
In case of coronary stenting in patients taking long-term oral anticoagulants (OAC), addition of both aspirin and clopidogrel in the drug regimen (so-called triple antiplatelet therapy) is recommended. However such triple therapy increases the risk of serious bleeding events. Comparative data on the efficacy and safety of the triple therapy versus therapy with a single antiplatelet agent and oral anticoagulants in case of coronary stenting are very rare. Most studies show a decreased stroke and myocardial infarction risk, but an increased risk of bleeding events in case of triple therapy. There is general agreement that, when possible, the duration of triple therapy should be shortened followed by clopidogrel and an oral anticoagulant to minimize bleeding risk without increasing other adverse events. In patients with a high risk of bleeding, BMS should be used and triple therapy should be applied for only 1month, followed by one antiplatelet agent and oral anticoagulant. The WOEST study was the first study showing that therapy with clopidogrel and OAC is safe and reduces bleeding and mortality more effectively than triple therapy including aspirin in patients undergoing coronary stenting. Although the risk of bleeding increases with triple therapy as compared to OAC plus a single antiplatelet agent, the second treatment regimen cannot be recommended to all patients. However for those at the highest risk of bleeding it is not unreasonable to consider. Additional randomized studies are needed for the implementation of future treatment guidelines in patients with high risk for bleeding and thrombotic complications.
Keywords: Atrial fibrillation, drug-eluting oral anticoagulation, stent, stent thrombosis.
Cardiovascular & Hematological Disorders-Drug Targets
Title:Triple Antiplatelet Therapy after PCI - Should or Could it be Done?
Volume: 14 Issue: 3
Author(s): Banu Sahin Yildiz, Mustafa Yildiz, Ebuzer Aydin and Ibrahim Akin
Affiliation:
Keywords: Atrial fibrillation, drug-eluting oral anticoagulation, stent, stent thrombosis.
Abstract: In case of coronary stenting in patients taking long-term oral anticoagulants (OAC), addition of both aspirin and clopidogrel in the drug regimen (so-called triple antiplatelet therapy) is recommended. However such triple therapy increases the risk of serious bleeding events. Comparative data on the efficacy and safety of the triple therapy versus therapy with a single antiplatelet agent and oral anticoagulants in case of coronary stenting are very rare. Most studies show a decreased stroke and myocardial infarction risk, but an increased risk of bleeding events in case of triple therapy. There is general agreement that, when possible, the duration of triple therapy should be shortened followed by clopidogrel and an oral anticoagulant to minimize bleeding risk without increasing other adverse events. In patients with a high risk of bleeding, BMS should be used and triple therapy should be applied for only 1month, followed by one antiplatelet agent and oral anticoagulant. The WOEST study was the first study showing that therapy with clopidogrel and OAC is safe and reduces bleeding and mortality more effectively than triple therapy including aspirin in patients undergoing coronary stenting. Although the risk of bleeding increases with triple therapy as compared to OAC plus a single antiplatelet agent, the second treatment regimen cannot be recommended to all patients. However for those at the highest risk of bleeding it is not unreasonable to consider. Additional randomized studies are needed for the implementation of future treatment guidelines in patients with high risk for bleeding and thrombotic complications.
Export Options
About this article
Cite this article as:
Yildiz Sahin Banu, Yildiz Mustafa, Aydin Ebuzer and Akin Ibrahim, Triple Antiplatelet Therapy after PCI - Should or Could it be Done?, Cardiovascular & Hematological Disorders-Drug Targets 2014; 14 (3) . https://dx.doi.org/10.2174/1871529X14666140825095243
DOI https://dx.doi.org/10.2174/1871529X14666140825095243 |
Print ISSN 1871-529X |
Publisher Name Bentham Science Publisher |
Online ISSN 2212-4063 |

- Author Guidelines
- Bentham Author Support Services (BASS)
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Therapeutic Effects of Renal Denervation on Renal Failure
Current Neurovascular Research Mechanisms of Endogenous Endothelial Repair in Stroke
Current Pharmaceutical Design Metabolic Syndrome as a Modifier of Atherosclerosis in Murine Models
Current Drug Targets Development and Validation of Novel UPLC-MS/MS Method for the Analysis of Macitentan in Pharmaceutical Formulations
Current Pharmaceutical Analysis Glycoprotein Targeting and Other Applications of Lectins in Biotechnology
Current Protein & Peptide Science Study of drug-drug combinations based on molecular descriptors and physicochemical properties
Combinatorial Chemistry & High Throughput Screening Targeting Apelinergic System in Cardiometabolic Disease
Current Drug Targets Determination of Residual Solvents in Eprosartan Mesylate by Static Headspace Gas Chromatographic Method Optimized by Response Surface Methodology
Current Pharmaceutical Analysis Inhibition of Zinc Metallopeptidases in Cardiovascular Disease - From Unity to Trinity, or Duality?
Current Pharmaceutical Design A Yeast Extract High in Bioactive Peptides has a Blood-Pressure Lowering Effect in Hypertensive Model
Current Medicinal Chemistry Optic Nerve and Cerebral Edema in the Course of Diabetic Ketoacidosis
Current Neuropharmacology Comparison of Vascular Responses to Vasoconstrictors in Human Placenta in Preeclampsia between Preterm and Later Term
Current Pharmaceutical Biotechnology DASH Dietary Pattern: A Treatment for Non-communicable Diseases
Current Hypertension Reviews HIV-1 Infection in Subjects Older than 70: A Multicenter Cross-Sectional Assessment in Catalonia, Spain
Current HIV Research Cilostazol: A New Drug in the Treatment Intermittent Claudication
Recent Patents on Cardiovascular Drug Discovery Potential Roles of MyomiRs in Cardiac Development and Related Diseases
Current Cardiology Reviews Clinical Science of Calcium Channel Blocker to Inhibit Hypertensive Vascular Injury
Current Hypertension Reviews Effect of Barley Grain on Memory and Brain’s Oxidative Stress Factors in Male Rats
The Natural Products Journal Beta-Blockers for the Treatment of Essential Hypertension: What are the Arguments Against Their Use as First Line Therapy?
Current Hypertension Reviews Unfolding Cardiac Amyloidosis –From Pathophysiology to Cure
Current Medicinal Chemistry