In case of coronary stenting in patients taking long-term oral anticoagulants (OAC), addition of both aspirin
and clopidogrel in the drug regimen (so-called triple antiplatelet therapy) is recommended. However such triple therapy
increases the risk of serious bleeding events. Comparative data on the efficacy and safety of the triple therapy versus
therapy with a single antiplatelet agent and oral anticoagulants in case of coronary stenting are very rare. Most studies
show a decreased stroke and myocardial infarction risk, but an increased risk of bleeding events in case of triple therapy.
There is general agreement that, when possible, the duration of triple therapy should be shortened followed by clopidogrel
and an oral anticoagulant to minimize bleeding risk without increasing other adverse events. In patients with a high risk of
bleeding, BMS should be used and triple therapy should be applied for only 1month, followed by one antiplatelet agent
and oral anticoagulant. The WOEST study was the first study showing that therapy with clopidogrel and OAC is safe and
reduces bleeding and mortality more effectively than triple therapy including aspirin in patients undergoing coronary
stenting. Although the risk of bleeding increases with triple therapy as compared to OAC plus a single antiplatelet agent,
the second treatment regimen cannot be recommended to all patients. However for those at the highest risk of bleeding it
is not unreasonable to consider. Additional randomized studies are needed for the implementation of future treatment
guidelines in patients with high risk for bleeding and thrombotic complications.
Keywords: Atrial fibrillation, drug-eluting oral anticoagulation, stent, stent thrombosis.
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