Patients with atrial fibrillation (AF), who meet the indication for oral anticoagulation (ie, CHA2DS2-VASC ≥2), and have concomitant coronary artery disease (CAD) with an indication for percutaneous coronary intervention (PCI) (which necessitates the use of dual anti-platelet therapy) continue to pose an important clinical challenge for physicians. It is not at all unusual for clinicians to be left wondering which combination of the following drugs provides the greatest efficacy for these patients along with the lowest risk for bleeding: aspirin, clopidogrel, a direct-acting anticoagulant (DOAC), and warfarin.
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There is a contemporary strategy among physicians for patients with AF and CAD to use “triple therapy” (aspirin, clopidogrel, and oral anticoagulation) for a short period of time following PCI, then drop the aspirin and use only clopidogrel and oral anticoagulation for the duration of the required antiplatelet therapy.
1. What study or body of evidence supports this strategy?
A. Clinical experience