title: Triple therapy for atrial fibrillation and percutaneous coronary intervention: a contemporary review.
abstract: Chronic oral anticoagulant therapy is recommended (class I) in patients with mechanical heart valves and in patients with atrial fibrillation with a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65 to 74 years, Sex category) score ≥1. When these patients undergo percutaneous coronary intervention with stenting, treatment with aspirin and a P2Y12 receptor inhibitor also becomes indicated. Before 2014, guidelines recommended the use of triple therapy (vitamin K antagonists, aspirin, and clopidogrel) for these patients. However, major bleeding is increasingly recognized as the Achilles' heel of the triple therapy regimen. Lately, various studies have investigated this topic, including a prospective randomized trial, and the evidence for adding aspirin to the regimen of vitamin K antagonists and clopidogrel seems to be weakened. In this group of patients, the challenge is finding the optimal equilibrium to prevent thromboembolic events, such as stent thrombosis and thromboembolic stroke, without increasing bleeding risk.
authors.affiliation: Department of Cardiology, Amphia Hospital, Breda, the Netherlands. Electronic address: willemdewilde@yahoo.com.
authors.forename: Willem J M
authors.initials: WJ
authors.lastname: Dewilde
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Paul W A
authors.initials: PW
authors.lastname: Janssen
authors.affiliation: Department of Cardiology, Onze Lieve Vrouwe Hospital (OLVG), Amsterdam, the Netherlands.
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.affiliation: Department of Cardiology, Gasthuisberg University Hospital Leuven, Leuven, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Adriaenssens
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors.forename: Morten L
authors.initials: ML
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Lamberts
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D000077144:Clopidogrel; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014812:Vitamin K / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: acenocoumarol; clopidogrel; dual antiplatelet therapy; oral anticoagulation; phenprocoumon; platelet aggregation