Triple antithrombotic therapy after ACS and PCI in patients on chronic oral anticoagulation: update

Marital status and cardiovascular disease risk

“…The Education in Heart article provides an update on the use of triple antithrombotic therapy after acute coronary syndromes or percutaneous coronary intervention in patients on chronic oral anticoagulation 6. The Image Challenge asks you to make the diagnosis of an interesting pericardial mass based on multi-modality imaging 7…”

Evolving paradigms in antithrombotic therapy for anticoagulated patients undergoing coronary stenting

“…AF and CAD share a number of pathophysiological mechanisms, that are reflected in the coexistence of CAD and AF in approximately 20–30% of patients. 1 With PCI being preferentially offered as a revascularization strategy in patients with CAD, in particular, the elderly, 9 the challenging therapeutic clinical context of coronary stenting in anticoagulated patients will be increasingly encountered by physicians. Triple antithrombotic therapy (TT), consisting of OAC, aspirin, and a P2Y 12 inhibitor, has been advocated and endorsed by international guidelines as a strategy that provides full protection from ischemic risk (class IIa, level of evidence B).…”

“…Based on this information, in this review we summarize and critically evaluate the evolving paradigms in the management of patients who have an indication for OAC treatment before or at the time of a PCI procedure. The management of patients who develop an indication for OAC treatment after PCI has been addressed elsewhere 1 and is beyond the scope of this review.…”

“…A sizable proportion of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) with stent implantation have an indication for treatment with oral anticoagulant (OAC) therapy. 1,2 The most common indication for OAC therapy in this group of patients, ranging approximately from 5% to 8% of all PCI candidates, 3 is represented by the prevention of stroke and thromboembolism due to atrial fibrillation (AF). In addition to OAC treatment, coronary stenting requires antiplatelet therapy to prevent the clinical sequelae of stent thrombosis (ST) and to reduce the burden of ischemic recurrences (i.e.…”