Triple Therapy: When, if Ever?

PURPOSE OF REVIEW: More than 9% of patients who undergo percutaneous coronary intervention (PCI) carry a concomitant indication for long-term anticoagulation (OAC). The optimal combination of anticoagulation and antiplatelet therapy for these patients remains uncertain.

RECENT FINDINGS: Numerous studies have demonstrated that dual antiplatelet therapy (DAPT) remains superior to vitamin K antagonists (VKA) in the prevention of stent-related events. Nonetheless, OAC therapy is more efficacious than DAPT at reducing thromboembolism in patients with atrial fibrillation. The combination of DAPT and OAC, known as triple therapy, portends as much as a threefold increased risk of fatal and nonfatal bleeding compared to warfarin monotherapy. Recent studies have demonstrated the safety of shorter durations of triple therapy with subsequent transition to a P2Y12 inhibitor in combination with an OAC. Here, we review the evidence regarding the safety and efficacy of dual therapy with OAC in combination with a P2Y12 inhibitor versus triple therapy among recently stented patients with a long-term requirement for OAC.