For Patients Needing Oral Anticoagulation for Atrial Fibrillation and Dual Antiplatelet Therapy after Percutaneous Coronary Intervention Is Double Therapy Preferred over Triple Therapy?

摘要

For many years clinicians have faced a conundrum in managing patients who require both oral anticoagulation and dual antiplatelet therapy after percutaneous coronary intervention (PCI). This scenario is commonly encountered in practice, given that approximately 20% of patients with atrial fibrillation will require PCI at some time, and up to 21% of patients with acute coronary syndrome (ACS) will also have new or established atrial fibrillation. The need for triple therapy—that is, the use of an oral anticoagulant and dual antiplatelet therapy—has not been studied with rigour but has been adopted in practice, as there have been no perceived alternatives. However, cohort studies have shown that triple therapy leads to an increased risk of major bleeds. We argue that there is now adequate evidence to avoid triple therapy and to change the standard of care for this population to double therapy, that is, the use of an anticoagulant (preferably a direct-acting oral anticoagulant) and a single antiplatelet agent (preferably a P2Y12 inhibitor).