Triple to Dual Antithrombotic After PCI in AF — EECC MCQ
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Correct answer: E — Short period of triple therapy (OAC + aspirin + clopidogrel) for 1 week, then dual therapy (OAC + clopidogrel) for up to 12 months, then OAC alone — minimising the triple therapy duration reduces bleeding
Patients with AF requiring anticoagulation who undergo PCI face competing risks of stent thrombosis (requiring antiplatelet therapy) and stroke (requiring OAC). The 2024 ESC AF Guidelines and 2023 ACS Guidelines recommend: (1) periprocedural: triple therapy (OAC + aspirin + P2Y12 — clopidogrel preferred over ticagrelor/prasugrel to minimise bleeding); (2) early: stop aspirin at 1 week (WOEST, AUGUSTUS, ENTRUST-AF PCI trials showed aspirin-free dual therapy reduces bleeding without increasing ischaemic events); (3) dual therapy (OAC + clopidogrel) for up to 6-12 months (depending on ischaemic vs bleeding risk); (4) then OAC alone long-term. DOACs are preferred over warfarin. This approach was validated by the AUGUSTUS, RE-DUAL PCI, and ENTRUST-AF PCI trials.
Reference: ESC (2024): AF Guidelines; ESC (2023): ACS Guidelines; AUGUSTUS Trial