Optimizing antithrombotic therapy after coronary stent implantation in patients on chronic oral anticoagulation.

Most patients on chronic oral anticoagulation have a lifelong indication. When these patients undergo percutaneous coronary interventions with stent implantation, they also have an indication for dual antiplatelet therapy (aspirin and a P2Y12 inhibitor). However, this so-called triple therapy results in increased bleeding risks which in turn is associated with increased mortality. Furthermore, emerging stronger antiplatelet drugs (prasugrel and ticagrelor) are associated with increased bleeding, making triple therapy even more hazardous. This created a clinical treatment dilemma for this subset of patients, and new trials have been designed to explore new treatment strategies. This review summarizes the available evidence regarding the optimal treatment of patients on chronic oral anticoagulation undergoing percutaneous coronary interventions with stent implantation.