“Triple Therapy” or Triple Threat?

Francescone, Steven; Halperin, Jonathan L.

doi:10.1016/j.jacc.2007.11.034

Cited by 22 publications

(5 citation statements)

References 23 publications

(12 reference statements)

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“…(2) Implantation of drug-eluting stents should be avoided in patients with a high hemorrhagic risk due to the prolonged need for dual antiplatelet administration. (3) For patients who are at risk for both thrombosis/thromboembolism and hemorrhage, bare metal stents are preferred, and a combination of clopidogrel and OAC should be used for 1 month before continuing to antithrombotic treatment with OAC 19,20…”

Section: Discussionmentioning

confidence: 99%

Medical treatment and long-term outcome of chronic atrial fibrillation in the aged with chest distress: a retrospective analysis versus sinus rhythm

Guo

Zhang²,

Wang³

et al. 2011

CIA

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Although “chest distress” is the most frequent complication in the aged with chronic atrial frbrillation (AF) in clinical practice, there are few data on the association between chronic AF and coronary artery disease (CAD) in the aged in terms of medical treatment and long-term outcome. We assessed coronary artery lesions in such patients and evaluated the efficacy of medical treatment in long-term follow-ups. Of 315 elderly patients (mean age: 77.39 ± 6.33 years) who had undergone coronary angiography for chest distress, 297 exhibited sinus rhythm (SR), whereas 18 patients exhibited chronic AF. Patients with AF were followed for 4.22 ± 2.21 years. Average diastolic blood pressure (DBP) of AF patients was observed to be markedly less than that of patients with SR (57.33 ± 6.87 mmHg vs 71.08 ± 10.54 mmHg, t-test: P < 0.01). Compared with SR patients, severe stenosis of the coronary artery in AF patients was reduced (73.06% vs 44.44%, Chi-square test: P < 0.01). AF patients with chest distress had high CHADS2 score (3.72 ± 1.27), but only 33.3% patients received oral anticoagulants, and such patients had a significantly lower rate of revascularization (21.43% vs 55.63%, Chi-square test: P < 0.01), and higher rate of all-cause death (22.22% vs 4.38%, Chi-square test: P < 0.01) and thromboembolism (16.67% vs 1.68%, Chi-square test: P < 0.01) in the long-term follow-ups compared with SR patients. Chest distress in the aged with AF was related to insufficient coronary blood supply that was primarily due to a reduced DBP rather than to occult CAD. Adequate and safe medical therapy was difficult to achieve in these patients. Such patients typically have a poor prognosis, and optimal therapeutic strategies to treat them are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Medical treatment and long-term outcome of chronic atrial fibrillation in the aged with chest distress: a retrospective analysis versus sinus rhythm

Guo

Zhang²,

Wang³

et al. 2011

CIA

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“…432 Because drug-eluting stents require even more prolonged antiplatelet therapy, bare metal stents are generally preferred for AF patients taking warfarin. 433,434 A lower target INR of 2.0 to 2.5 has been recommended in patients requiring warfarin, aspirin, and clopidogrel after percutaneous coronary intervention during the period of combined antiplatelet and anticoagulant therapy. 435 …”

Section: Well-documented and Modifiable Risk Factorsmentioning

confidence: 99%

Guidelines for the Primary Prevention of Stroke

Meschia¹,

Bushnell²,

Boden‐Albala³

et al. 2014

Stroke

1,594

586

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The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

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“…In previous studies, triple antiplatelet therapy was shown to be more effective after PCI for preventing stent thrombosis or major cardiovascular events than dual antiplatelet therapy 6-11). Currently, it is not clear whether triple therapy induces bleeding more frequently than dual therapy 12). For recurrent stent thrombosis, oral anticoagulation can be considered as an option,13)14) although there is controversy regarding the value of warfarin administration after PCI.…”

Section: Discussionmentioning

confidence: 99%

Fatal Renal Bleeding in a Patient Treated With Aggressive Antithrombotic Therapy After Recurrent Coronary Stent Thrombosis

et al. 2010

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Triple antiplatelet therapy has been known to be superior to the conventional dual regimen for preventing stent thrombosis after coronary stenting, and the addition of oral anticoagulation to antiplatelet therapy is also considered an option. However, the risks and benefits of a triple antiplatelet regimen plus additional oral anticoagulation must be taken into account. Here, we report a case of fatal renal bleeding in a patient treated with triple antiplatelet plus oral anticoagulant therapy for the prevention of recurrent stent thrombosis.

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“Triple Therapy” or Triple Threat?

Cited by 22 publications

References 23 publications

Medical treatment and long-term outcome of chronic atrial fibrillation in the aged with chest distress: a retrospective analysis versus sinus rhythm

Medical treatment and long-term outcome of chronic atrial fibrillation in the aged with chest distress: a retrospective analysis versus sinus rhythm

Guidelines for the Primary Prevention of Stroke

Fatal Renal Bleeding in a Patient Treated With Aggressive Antithrombotic Therapy After Recurrent Coronary Stent Thrombosis

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