Do Ingredients Make the Difference? Finding the Best Cocktail of an Anticoagulant with Antiplatelets
In clinical practice, the need for adding one or two antiplatelet agents to an oral anticoagulant (OAC) often arises in patients with atrial fibrillation (AF). The indications can be diverse, from primary prevention in patients at high risk for an ischemic atherosclerotic event, over secondary prevention after an acute coronary syndrome (ACS) to prevention of stent thrombosis.1,2 Unfortunately, adding antiplatelet agents to oral anticoagulants increases bleeding risk, and although this risk is highest early after initiation of combination therapy, there appears to be no safe therapeutic window.1 The difficulty lies in balancing thromboembolic risk versus bleeding risk in the individual patient. Since many new agents came on the market recently, there are a wide variety of possible strategies not only with regard the number and type of agents but also the intensity of anticoagulation and the duration of the combination treatment.
- Received December 17, 2012.
- Accepted December 18, 2012.
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