Clinical Considerations Prior to Transition from Triple Antithrombotic Therapy to Dual Antithrombotic Therapy

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Published Online: December 4, 2019. doi:10.1001/jamacardio.2019.4551 Conflict of Interest Disclosures: Dr Harskamp has received grants from the Dutch Research Council. Dr Alexander has received grants from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, CryoLife, CSL Behring, the US Food and Drug Administration, the National Institutes of Health, Sanofi, and VoluMetrix and personal fees from AbbVie, Bristol-Myers Squibb, CSL Behring, Novo Nordisk, Pfizer, Portola Pharmaceuticals, Quantum Genomics, Teikoku Pharma, VA Cooperative Studies Program, and Zafgen. Dr Lopes has received grants from Bristol-Myers Squibb, Pfizer, Amgen, GlaxoSmithKline, Medtronic, and Sanofi Aventis and personal fees from Bristol-Myers Squibb, Pfizer, Bayer, and Boehringer Ingelheim. 1. Lopes RD, Hong H, Harskamp RE, et al. Safety and efficacy of antithrombotic strategies in patients with atrial fibrillation undergoing percutaneous coronary intervention: a network meta-analysis of randomized controlled trials. JAMA Cardiol. 2019;4(8):747-755. doi:10.1001/jamacardio.2019.1880 2. Cannon CP, Bhatt DL, Oldgren J, et al; RE-DUAL PCI Steering Committee and Investigators. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017;377(16):1513-1524. doi:10.1056/NEJMoa1708454 3. Gibson CM, Mehran R, Bode C, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016;375(25):2423-2434. doi:10. 1056/NEJMoa1611594 4. Lopes RD, Heizer G, Aronson R, et al; AUGUSTUS Investigators. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med. 2019;380(16):1509-1524. doi:10.1056/NEJMoa1817083 5. Dewilde WJM, Oirbans T, Verheugt FWA, et al; WOEST study investigators. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013;381(9872):1107-1115. doi:10.1016/ S0140-6736(12)62177-1