Triple Antithrombotic Therapy With Prasugrel in the Stented Patient Concern for More Bleeding ⁎ ⁎

There is a large body of evidence, including results of prospective trials, that supports oral anticoagulation therapy (OAT) as the optimal strategy to prevent fibrin-centric thrombotic events (FCTEs). Examples of FCTEs include thromboembolism in patients with mechanical heart valves, deep vein thrombosis, and atrial fibrillation (AF) (1). In a large prospective trial, warfarin was found to be superior to dual antiplatelet therapy (DAPT) with aspirin + clopidogrel in the prevention of vascular events in patients with AF plus 1 or more risk factors for stroke (2). European and American guidelines include a Class I recommendation for lifelong OAT in patients with AF who are at moderate to high risk of thromboembolism (3). It has also been demonstrated in prospective, randomized trials that DAPT with aspirin and a thienopyridine is superior to aspirin + warfarin in the prevention of the platelet-centric thrombotic event (PCTE), stent thrombosis (4). In the European and American Guidelines there is a Class I recommendation to administer uninterrupted DAPT for 1 to 12 months depending on the type of stent used (5,6).
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - Category: Cardiology Source Type: research