A Review of Triple Therapy in Acute Coronary Syndromes

AbstractPurpose of ReviewThis review provides a summary of the new literature surrounding the concomitant use of anticoagulation with direct oral anticoagulants (DOACs) and antiplatelet agents following acute coronary syndromes (ACS) and percutaneous intervention (PCI).Recent FindingsThe American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA) and the American College of Chest Physicians (CHEST) provide weak recommendations for clinical situations in which patients require anticoagulation and dual antiplatelet therapy with aspirin and a P2Y12 inhibitor, also known as triple therapy. Recent investigations have compared double therapy regimens with a DOAC and P2Y12 inhibitor to triple therapy to provide insight into the optimal regimen that balances safety and efficacy.SummaryThe PIONEER AF-PCI and RE-DUAL PCI trials compared double therapy regimens with rivaroxaban and dabigatran, respectively, to triple therapy regimens with warfarin following PCI. Both studies found that double therapy with a DOAC and P2Y12 inhibitor was associated with less bleeding and similar rates of thromboembolic events as compared to the warfarin triple therapy regimen. Apixaban and edoxaban are currently being evaluated in similar randomized trials.
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research