open access

Vol 76, No 6 (2018)
Reviews
Published online: 2018-05-17
Submitted: 2018-05-14
Accepted: 2018-05-14
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Dual and triple antithrombotic therapies: current patterns of practice and controversies

Mark A. Crowther, John W. Eikelboom
DOI: 10.5603/KP.a2018.0112
·
Kardiol Pol 2018;76(6):937-944.

open access

Vol 76, No 6 (2018)
Reviews
Published online: 2018-05-17
Submitted: 2018-05-14
Accepted: 2018-05-14

Abstract

Dual antiplatelet therapy (DAPT) has been the cornerstone of antithrombotic management for patients undergoing percu­taneous coronary intervention (PCI). Despite low-quality evidence, triple antithrombotic therapy involving acetylsalicylic acid, clopidogrel, and warfarin or non-vitamin K antagonist oral anticoagulant (NOAC) has been recommended in patients with concomitant atrial fibrillation undergoing PCI, who require long-term oral anticoagulation, although such a strategy is associated with a substantially increased risk of bleeding compared with DAPT. NOAC combined with P2Y12 inhibitor alone appears to be safer and as effective as triple therapy with warfarin in patients with acute coronary syndromes based on the results of recent randomised trials on dabigatran and rivaroxaban. The present review summarises the current data on various combinations of antithrombotic agents in terms of their efficacy and safety.

Abstract

Dual antiplatelet therapy (DAPT) has been the cornerstone of antithrombotic management for patients undergoing percu­taneous coronary intervention (PCI). Despite low-quality evidence, triple antithrombotic therapy involving acetylsalicylic acid, clopidogrel, and warfarin or non-vitamin K antagonist oral anticoagulant (NOAC) has been recommended in patients with concomitant atrial fibrillation undergoing PCI, who require long-term oral anticoagulation, although such a strategy is associated with a substantially increased risk of bleeding compared with DAPT. NOAC combined with P2Y12 inhibitor alone appears to be safer and as effective as triple therapy with warfarin in patients with acute coronary syndromes based on the results of recent randomised trials on dabigatran and rivaroxaban. The present review summarises the current data on various combinations of antithrombotic agents in terms of their efficacy and safety.

Get Citation

Keywords

dual antiplatelet therapy, atrial fibrillation, anticoagulation, bleeding; triple therapy

About this article
Title

Dual and triple antithrombotic therapies: current patterns of practice and controversies

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 6 (2018)

Pages

937-944

Published online

2018-05-17

DOI

10.5603/KP.a2018.0112

Bibliographic record

Kardiol Pol 2018;76(6):937-944.

Keywords

dual antiplatelet therapy
atrial fibrillation
anticoagulation
bleeding
triple therapy

Authors

Mark A. Crowther
John W. Eikelboom

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