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Optimal Antithrombotic Therapy in Patients Receiving Long-term Oral Anticoagulation Requiring Percutaneous Coronary Intervention: “Triple Therapy” or “Triple Threat”

Luke D. Tapp; Gregory Y. H. Lip, MD; Deirdre A. Lane, PhD
Author and Funding Information

From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital.

Correspondence to: Deirdre A. Lane, PhD, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, England; e-mail: deirdre.lane@swbh.nhs.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(2):240-242. doi:10.1378/chest.10-1102
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Extract

The number of patients requiring long-term oral anticoagulation (OAC), usually warfarin, for a variety of conditions, predominantly atrial fibrillation (AF), mechanical prosthetic heart valves, or previous systemic or VTE, is rapidly increasing.1 In parallel, the number of patients undergoing percutaneous coronary intervention (PCI) with stent implantation, either electively or for acute coronary syndrome, where dual antiplatelet therapy (DAPT) with aspirin and a thienopyridine (most commonly clopidogrel) is mandatory to prevent stent thrombosis,2-4 is also escalating. Consequently, physicians are faced with tough management decisions regarding the optimal antithrombotic strategy for patients with a current indication for long-term OAC who also require PCI and stent implantation.3,4 Unfortunately, there are no large-scale randomized trials of dual and triple antithrombotic therapy in this setting. Treatment options are controversial3,4 because current guidelines are an evidence-based medicine-free zone.

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