Comparing anti-blood clotting therapies after a percutaneous coronary intervention

This paper studied what the optimal medical therapy after a percutaneous coronary intervention should be. Researchers concluded that dual therapy was associated with lower bleeding rates compared to triple therapy. 

A percutaneous coronary intervention is a non-surgical procedure done to improve blood flow to the heart. It involves the placement of a small structure called a stent to open up blood vessels in the heart that have been narrowed. Aspirin and antiplatelets are drugs used to thin the blood and prevent blood from sticking together. Clopidogrel (Plavix) is one of the main antiplatelets used. These drugs reduce the risk of heart attacks and clots after a percutaneous coronary intervention. Which therapy is most suitable after a percutaneous coronary intervention is still being investigated.

15 studies involving 7,182 patients were analyzed.

In 9 studies, 1,317 patients were treated with dual antiplatelet therapy (DAPT) involving aspirin and clopidogrel. 1,547 patients were treated with triple therapy involving aspirin, clopidogrel, and an oral anticoagulant (type of drug that prevents blood from clotting). After a follow-up of 1 year, major bleedings were reported in 2.5% of patients receiving DAPT. Major bleedings occurred in 5.5% of those on triple therapy. Patients receiving DAPT were 49% less at risk of major bleeding compared to patients on triple therapy.

In 6 studies, 1,263 patients received dual therapy involving an oral anticoagulant and clopidogrel. 3,055 patients received triple therapy involving an oral anticoagulant, aspirin and clopidogrel. Results showed that dual therapy significantly reduced the risk of bleeding by 21% compared to triple therapy. There was no significant difference in rates of death, heart attack and stroke.  

Researchers concluded that, compared to triple therapy, both a combination of aspirin and clopidogrel or clopidogrel and an oral anticoagulant have lower bleeding rates.  

The methods used in each study involved may have varied slightly.