Combination of anticoagulant and antiaggregant treatment in patients after myocardial infarction with an indication for anticoagulant treatment –  so‑ called triple therapy

Authors: R. Lábrová
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno
Published in: Kardiol Rev Int Med 2014, 16(6): 464-471
Category: Cardiology Review


Anticoagulant therapy is indicated in patients with artificial heart valves, in most patients with atrial fibrillation and in thromboembolic diseases to reduce embolisms. Dual antiaggregant treatment fails in these indications. Patients who have suffered from acute coronary syndrome have a higher risk of cardiovascular complications. If these patients undergo percutaneous coronary intervention with stent implantation, dual antiaggregation is indicated in order to reduce the risk of ischemic attacks, most often with acetylsalycic acid and clopidogrel or newer irreversible blockers of adenosine diphosphate receptors –  ticagrelol or prasugrel. However, the combination of both kinds of treatment –  anticoagulation and dual antiaggregation, known as triple therapy –  increases the risk of bleeding. The ideal therapy for patients with an indication for chronic anticoagulant therapy and receiving percutaneous intervention treatment that would stop thrombotic complications without a higher risk of bleeding is still being sought. The first prospective randomized study, WOEST, showed that warfarin and clopidogrel without acetylsalycic acid is no worse than triple therapy in prevention of thromboembolic complications, and significantly reduces the risk of bleeding. However, this study has not answered the question regarding the administration of ticagrelol or prasugrel. Another question is the administration of the new oral anticoagulants replacing warfarin in indicated cases, in combination with dual antiaggregation.

Key words:
oral anticoagulants –  antiplatelet therapy –  triple therapy –  acute coronary syndrome –  percutaneous coronary intervention


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