Triple antiplatelet therapy and combinations with oral anticoagulants after PCI

Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12- receptor antagonist, is recommended following stent implantation during percutaneous coronary intervention (PCI), by European and North American guidelines. This chapter reviews the safety and efficacy of triple antiplatelet and antithrombotic regimens, following PCI. It examines the preliminary data regarding novel oral anticoagulants, summarizes the latest evidence-based clinical guidelines, and addresses questions that remain unanswered regarding the optimal clinical use of such antithrombotic regimens. Antithrombotic drugs are classified in two main categories: antiplatelet agents, which act via inhibition of platelet recruitment, adhesion, aggregation, or activation, and anticoagulant agents, which act via inhibition of critical components of the coagulation cascade. The addition of cilostazol to present Triple Antiplatelet Therapy (TAPT) regimens may be associated with improved outcomes, particularly for patients known to be at high risk of recurrent adverse events following PCI.