Clinicians should carefully consider the risks and benefits of triple therapy, as new research in the Journal of the American College of Cardiology reports that in older patients with acute myocardial infarction (MI) and atrial fibrillation (AF), triple therapy did not reduce the risk of major cardiovascular events but was associated with a greater risk of bleeding.
Data from the National Cardiovascular Data Registry ACTION Registry-GWTG on 4,959 patients aged ≥65 with acute MI and AF treated with percutaneous coronary intervention (PCI) from 2007–2010 was evaluated; about 72% of the patients were discharged on dual antiplatelet therapy (DAPT) and approximately 28% on triple therapy (DAPT plus warfarin). Two-year major adverse cardiac events (MACE) including death, readmission for MI, or stroke were assessed and the primary safety outcome was bleeding readmission.
Patients on triple therapy had a similar risk of MACE, but a significantly greater risk of bleeding requiring hospitalization and a greater risk of intracranial hemorrhage. An accompanying editorial added that “more” does not appear to be “better” with antiplatelet therapy, but that there may not be suitable alternatives at this point.
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