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Triple Antithrombotic Avoidance — RACP Adult Medicine MCQ

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HardGeneral Internal MedicineTriple Antithrombotic AvoidanceRACP Adult Medicine

A 55-year-old had uncomplicated PCI three years ago and has had no recurrent coronary event. He now requires full-dose rivaroxaban for proximal deep-vein thrombosis and is still taking aspirin plus clopidogrel without another indication. What is the preferred antithrombotic plan?

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Correct answer: D — Use therapeutic anticoagulation alone and cease both antiplatelet medicines after confirming the remote PCI history

The best answer is “Use therapeutic anticoagulation alone and cease both antiplatelet medicines after confirming the remote PCI history”. Beyond the period in which coronary stent protection requires antiplatelet therapy, a patient who develops a separate indication for full-dose anticoagulation is generally managed with anticoagulation alone. Continuing one or two antiplatelets adds bleeding without proven benefit in stable remote PCI. Dual antiplatelet therapy does not treat venous thrombosis, and changing anticoagulant class does not justify unnecessary triple therapy.

Reference: Heart Foundation and CSANZ: Australian acute coronary syndromes guideline 2025: https://www.heartfoundation.org.au/for-professionals/acs-guideline Medical Journal of Australia: Australasian venous thromboembolism guideline: https://www.mja.com.au/journal/2019/new-guidelines-venous-thromboembolism