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  • Review Article
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Drug Insight: antithrombotic therapy after percutaneous coronary intervention in patients with an indication for anticoagulation

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 673–680 (2006)Cite this article

Abstract

Antiplatelet therapy with aspirin and clopidogrel is standard care following revascularization by percutaneous coronary intervention with stent insertion. This so-called dual therapy is recommended for up to 4 weeks after intervention for bare-metal stents and for 6–12 months after intervention for drug-eluting stents. Although it is estimated that 5% of patients undergoing percutaneous coronary intervention require long-term anticoagulation because of an underlying chronic medical condition, continuing treatment with triple therapy (warfarin, aspirin and clopidogrel) increases the risk of bleeding. In most patients triple antithrombotic therapy seems justified for a short period of time. In some patients, however, a more considered judgment based on absolute need for triple therapy, risk of bleeding and risk of stent thrombosis is required, but the optimum antithrombotic treatment for these patients who require long-term anticoagulation has not been defined. This Review summarizes the existing literature concerning antithrombotic therapy and makes recommendations for initiation and duration of triple therapy in the small proportion of patients already receiving anticoagulant therapy who require percutaneous coronary intervention.

Key Points

  • An estimated 5% of patients requiring percutaneous revascularization require long-term anticoagulation therapy

  • As the optimum antiplatelet therapy duration is not known, a balance has to be made between the risks of thromboembolism, bleeding and stent thrombosis

  • Only limited and circumstantial evidence is available for best antithrombotic practice after percutaneous coronary revascularization in patients who require long-term oral anticoagulation, and thus determining the type and duration of antithrombotic therapy needs to be made on an individual basis

  • Coronary lesions should be carefully evaluated before revascularization

  • Bare-metal stents, requiring reduced antiplatelet therapy duration, should be considered in patients requiring long-term anticoagulation therapy

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Authors and Affiliations

  1. Professors of Cardiology at La Pitié-Salpêtrière Hospital in Paris,

    Gérard Helft, Martine Gilard & Claude Le Feuvre

  2. interventional cardiologist at La Cavale Blanche Hospital, Brest University Hospital, Brest, France

    Gérard Helft, Martine Gilard & Claude Le Feuvre

  3. honorary clinical senior lecturer at the University of Newcastle, Newcastle-upon-Tyne, UK

    Azfar G Zaman

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  1. Gérard Helft
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  2. Martine Gilard
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  3. Claude Le Feuvre
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  4. Azfar G Zaman
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Correspondence to Gérard Helft.

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The authors declare no competing financial interests.

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Helft, G., Gilard, M., Le Feuvre, C. et al. Drug Insight: antithrombotic therapy after percutaneous coronary intervention in patients with an indication for anticoagulation. Nat Rev Cardiol 3, 673–680 (2006). https://doi.org/10.1038/ncpcardio0712

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