Who should receive triple antithrombotic therapy?
Finer points: Jeremy Paikin, MD, and colleagues published a summary of the efficacy and safety of triple antithrombotic therapy in patients with atrial fibrillation who are receiving warfarin for stroke prevention and subsequently present with an acute coronary syndrome requiring placement of a coronary artery stent and the addition of dual antiplatelet therapy with clopidogrel and aspirin. The authors wrote that there are no well-designed, randomized trials that have evaluated the efficacy of triple antithrombotic therapy with warfarin, clopidogrel, and aspirin compared with either treatment alone. Paikin and colleagues wrote that they did not believe that the efficacy of warfarin would be affected by the addition of dual antiplatelet therapy; however, they acknowledged that the risk of major bleeding would be increased. A meta-analysis of 10 observational studies including 1,349 patients who received triple antithrombotic therapy showed that the 30-day major bleeding rate was 2.2% (9
