Aspirin, warfarin and a thienopyridine for acute coronary syndromes.
BACKGROUND
Although clopidogrel and aspirin (dual therapy, DT) are used for acute coronary syndrome (ACS), sometimes treatment with warfarin (triple therapy, TT) is required.


OBJECTIVE
To determine the incidence, complications, and outcomes of TT.


METHODS
We analyzed Israeli surveys of ACS from 2000 to 2004.


RESULTS
In these surveys, 5,706 (96%) were discharged alive from hospital. Post-ACS TT and DT were 76 patients (1.3%) and 2,661 patients (46.7%), respectively. The TT group was older with more prior cardiac disease. During hospitalization, the TT patients received more intravenous anticoagulant and antithrombotic agents, and had more heart failure, arrhythmias, ischemia, and major bleeding (2.6 vs. 0.6%, p=0.03). There were no differences in adjusted 30-day and 6-month mortality between the 2 groups.


CONCLUSIONS
TT is feasible among ACS patients who require concomitant warfarin treatment.
Konstantino
Yuval
Y
Department of Cardiology, Rabin Medical Center, Petah-Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Iakobishvili
Zaza
Z
Porter
Avital
A
Sandach
Amir
A
Zahger
Doron
D
Hod
Hanoch
H
Hammerman
Haim
H
Gottlieb
Shmuel
S
Behar
Solomon
S
Hasdai
David
D
D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D000077144:Clopidogrel; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D006401:Hematologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013577:Syndrome; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016276:Ventricular Function; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
D006401:Hematologic Agents; D011725:Pyridines; C446540:thienopyridine; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin