TY - JOUR
T1 - Coronary Stent Implantation in Patients Committed to Long-term Oral Anticoagulation Therapy Successfully Navigating the Treatment Options
AU - Rubboli, A
AU - Kovacic, JC
AU - Mehran, R
AU - Lip, Gregory
PY - 2011/5/1
Y1 - 2011/5/1
N2 - Current guidelines and recommendations on the antithrombotic management of patients committed to long-term oral anticoagulation (OAC) therapy undergoing coronary stent implantation are recognized to be flawed by numerous limitations. Nevertheless, triple therapy (TT) (warfarin, aspirin, and clopidogrel) is regarded as the most effective regimen for preventing major adverse cardiac events, stent thrombosis, and stroke, albeit at the price of an increased risk of bleeding. Recent insights into the efficacy and safety of TT derived from larger, prospective studies have expanded current knowledge by showing that TT is likely associated with minor, rather than major bleeding, and that accurate stratification of thromboembolic and hemorrhagic risk may enable optimization of the antithrombotic strategy at discharge. Therefore, TT should be prescribed to patients at moderate to high thromboembolic risk, owing to a favorable net clinical benefit. Discontinuation of OAC and substitution with dual antiplatelet therapy is the optimal strategy for patients at low thromboembolic risk. CHEST 2011;139(5):981-987
AB - Current guidelines and recommendations on the antithrombotic management of patients committed to long-term oral anticoagulation (OAC) therapy undergoing coronary stent implantation are recognized to be flawed by numerous limitations. Nevertheless, triple therapy (TT) (warfarin, aspirin, and clopidogrel) is regarded as the most effective regimen for preventing major adverse cardiac events, stent thrombosis, and stroke, albeit at the price of an increased risk of bleeding. Recent insights into the efficacy and safety of TT derived from larger, prospective studies have expanded current knowledge by showing that TT is likely associated with minor, rather than major bleeding, and that accurate stratification of thromboembolic and hemorrhagic risk may enable optimization of the antithrombotic strategy at discharge. Therefore, TT should be prescribed to patients at moderate to high thromboembolic risk, owing to a favorable net clinical benefit. Discontinuation of OAC and substitution with dual antiplatelet therapy is the optimal strategy for patients at low thromboembolic risk. CHEST 2011;139(5):981-987
U2 - 10.1378/chest.10-2719
DO - 10.1378/chest.10-2719
M3 - Editorial
C2 - 21540213
VL - 139
SP - 981
EP - 987
JO - Chest
JF - Chest
IS - 5
ER -