Conclusion of Percutaneous Coronary Intervention In Patients Who Have An Indication For Oral Anticoagulation – An Evidence-Based Approach To Antithrombotic Therapy

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Summary

Conclusion

The optimal antithrombotic regimen following PCI in patients who require OAC is yet to be determined. The different balance in individual patients between their risk of arterial or venous thrombotic events, stent thrombosis and bleeding means that there is unlikely to be a single antithrombotic regimen of choice for all patients who have an indication for OAC after PCI. Current guidelines recommend triple therapy comprising aspirin, clopidogrel and either warfarin or a NOAC in the post-procedure period for all patients who have a clear indication for OAC in order to reduce their risk of stent thrombosis and thrombotic arterial or venous events. However, this regimen is associated with a high rate of bleeding complications. Recently published trials suggest that DAPT (and thereby triple therapy in patients who require OAC) can be limited safely to three months, and potentially to one month, following the deployment of new-generation DES without an excess risk of stent thrombosis. Furthermore, triple therapy may be unnecessary, the combination of OAC plus clopidogrel (without aspirin) providing similar protection against stroke and stent thrombosis but with a significant reduction in bleeding compared with triple therapy in one randomised trial.

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