title: Combining antiplatelet and antithrombotic therapy (triple therapy): what are the risks and benefits?
abstract: Most patients with mechanical heart valves and many patients with atrial fibrillation will require long-term anticoagulation therapy. For patients with mechanical prosthetic valves, only warfarin is indicated. However, for patients with nonvalvular atrial fibrillation who are at increased risk for embolic stroke, one of the newer antithrombotic medications, such as rivaroxaban, dabigatran, and apixaban, also can be used. Patients with indications for antithrombotic therapy often will have coexisting vascular disease, such as coronary artery disease, requiring concomitant antiplatelet therapy with aspirin alone or more commonly with a dual antiplatelet regimen, aspirin and clopidogrel, or prasugrel or ticagrelor. The risks and benefits of this approach are still not well defined, and current guidelines have included recommendations based primarily on expert opinion.
authors.affiliation: University of Arizona College of Medicine, Tucson, Ariz. Electronic address: aasencio@shc.arizona.edu.
authors.forename: Luis Alejandro
authors.initials: LA
authors.lastname: Asencio
authors.affiliation: University of Arizona College of Medicine, Tucson, Ariz.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Huang
authors.affiliation: University of Arizona College of Medicine, Tucson, Ariz.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Alpert
mesh_terms: D001241:Aspirin / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D018570:Risk Assessment; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Acute coronary syndrome; Anticoagulation; Antithrombotic therapy; Aspirin; Atrial fibrillation; Clopidogrel; Coronary intervention; Coronary stent; Drug-eluting stent; Platelet inhibitor; Stent; Triple therapy; Warfarin