Coronary stent implantation in patients committed to long-term oral anticoagulation therapy: successfully navigating the treatment options.

Abstract

Current guidelines and recommendations on the antithrombotic management of patients committed to long-term oral anticoagulation (OAC) therapy undergoing coronary stent implantation are recognized to be flawed by numerous limitations. Nevertheless, triple therapy (TT) (warfarin, aspirin, and clopidogrel) is regarded as the most effective regimen for preventing major adverse cardiac events, stent thrombosis, and stroke, albeit at the price of an increased risk of bleeding. Recent insights into the efficacy and safety of TT derived from larger, prospective studies have expanded current knowledge by showing that TT is likely associated with minor, rather than major bleeding, and that accurate stratification of thromboembolic and hemorrhagic risk may enable optimization of the antithrombotic strategy at discharge. Therefore, TT should be prescribed to patients at moderate to high thromboembolic risk, owing to a favorable net clinical benefit. Discontinuation of OAC and substitution with dual antiplatelet therapy is the optimal strategy for patients at low thromboembolic risk.