[How and when to use dual antiplatelet treatment in the patient treated with oral anticoagulants?].
The optimal antithrombotic treatment for patients on oral anticoagulation (OAC) undergoing coronary artery stenting is currently undefined. In this review, the currently available evidence is examined, and practical recommendations for the management of these patients are given. Triple therapy with aspirin, clopidogrel and OAC is the most effective treatment to prevent stent thrombosis and thromboembolism related to the clinical conditions for which OAC is indicated. Because of its association with a relevant hemorrhagic risk, however, it should be reserved to conditions at high thromboembolic risk and administered for the shortest possible time. Owing to the more rapid re-endothelization, bare-metal stents should be preferred. On the contrary, the use of drug-eluting stents should be limited, and absolutely avoided in the presence of high hemorrhagic risk. In this case, the implantation of bare-metal stents associated with only 2 weeks of triple therapy is recommended. The efficacy of the combination of aspirin and OAC is suboptimal, so that such regimen must not be used. On the other hand, the safety and efficacy profiles of the combination of clopidogrel and OAC, although not supported at present by solid data, appears similar to that of other antithrombotic combinations. The above recommendations are derived from small and uncontrolled populations, which were retrospectively examined. Therefore, large-scale prospective studies are needed to determine the optimal antithrombotic treatment in this patient population.
Rubboli
Andrea
A
Laboratorio di Emodinamica, U.O. di Cardiologia, Ospedale Maggiore, Largo Nigrisoli, 2, 40133 Bologna. andrearubboli@libero.it
Di Pasquale
Giuseppe
G
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D003331:Coronary Vessels / Q000601:surgery*; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors