Is it Time to Curtail Triple Antithrombotic Therapy by Omitting Aspirin?

Abstract

Antithrombotic therapy is a continuously evolving field. However, as the number of available oral antiplatelet and anticoagulant agents continues to grow, so does the uncertainty regarding optimal combination therapy, as clinicians are increasingly faced with coadministration of therapies whose combined effects have not been fully evaluated. Perhaps, the most common and difficult of these scenarios is the use of dual antiplatelet therapy in patients who require chronic oral anticoagulation. Although each of these treatments has clear benefits, there is concern about bleeding risk when they are used together, in the so called “triple therapyâ€. The obvious conflict raised by the prospect of triple therapy, is a more complete ischemic/ thromboembolic protection in the face of significantly increased bleeding risk and perhaps bleeding-related mortality. Accumulating data provide evidence to curtail triple therapy by omitting aspirin, when oral anticoagulation is needed for atrial fibrillation, while dual therapy with oral anticoagulation plus clopidogrel seems a safer and perhaps equally effective strategy compared with triple therapy.