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Triple Therapy: When, if Ever?

  • Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

More than 9% of patients who undergo percutaneous coronary intervention (PCI) carry a concomitant indication for long-term anticoagulation (OAC). The optimal combination of anticoagulation and antiplatelet therapy for these patients remains uncertain.

Recent findings

Numerous studies have demonstrated that dual antiplatelet therapy (DAPT) remains superior to vitamin K antagonists (VKA) in the prevention of stent-related events. Nonetheless, OAC therapy is more efficacious than DAPT at reducing thromboembolism in patients with atrial fibrillation. The combination of DAPT and OAC, known as triple therapy, portends as much as a threefold increased risk of fatal and nonfatal bleeding compared to warfarin monotherapy. Recent studies have demonstrated the safety of shorter durations of triple therapy with subsequent transition to a P2Y12 inhibitor in combination with an OAC.

Summary

Here, we review the evidence regarding the safety and efficacy of dual therapy with OAC in combination with a P2Y12 inhibitor versus triple therapy among recently stented patients with a long-term requirement for OAC.

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  1. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 8-800, Boston, MA, 02114, USA

    Nino Mihatov MD, Eric A. Secemsky MD MSc & Sammy Elmariah MD MPH

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Nino Mihatov and Eric A. Secemsky each declare no potential conflicts of interest.

Sammy Elmariah declares a grant from Boehringer Ingelheim.

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Mihatov, N., Secemsky, E.A. & Elmariah, S. Triple Therapy: When, if Ever?. Curr Treat Options Cardio Med 20, 61 (2018). https://doi.org/10.1007/s11936-018-0639-6

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