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Triple Antithrombotic Therapy Becoming Growing Concern

Last Updated: July 01, 2009.

Given that the number of patients requiring warfarin and dual antiplatelet therapy is expected to rise, clinicians should give thought to the best use of these therapies to balance their benefits and risks, according to a review published in the July 7 issue of the Journal of the American College of Cardiology.

WEDNESDAY, July 1 (HealthDay News) -- Given that the number of patients requiring warfarin and dual antiplatelet therapy is expected to rise, clinicians should give thought to the best use of these therapies to balance their benefits and risks, according to a review published in the July 7 issue of the Journal of the American College of Cardiology.

David R. Holmes, Jr., M.D., of the Mayo Clinic in Rochester, Minn., and colleagues write that dual antiplatelet therapy, typically aspirin plus clopidogrel, has become commonly accepted for acute coronary syndromes and coronary stent deployment. Warfarin, however, has become standard in patients with atrial fibrillation, prosthetic heart valves, and reduced left ventricular function. Triple antithrombotic therapy, containing both of these approaches, is expected to become more common as the population ages.

Patients receiving triple therapy should receive as low of a dose of aspirin as possible, a standard dose of clopidogrel at 75 milligrams daily, and warfarin that achieves an international normalized ratio of 2.0 to 2.5, the authors write. In the case of bleeding events or a high risk of gastrointestinal bleeding, aspirin may be discontinued. Discontinuing the thienopyridine component of dual therapy is more commonly linked to stent thrombosis or death or myocardial infarction after stent deployment.

"Before committing a patient to triple therapy for an indefinite period, the physician should carefully consider approaches that might not require prolonged dual antiplatelet therapy in conjunction with warfarin," the authors conclude.

Two co-authors reported financial relationships with several pharmaceutical companies.

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