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drug interaction(s) of aspirin, P2Y12 inhibitors & anticoagulants
Indications:
- acute coronary syndrome, myocardial infarction or coronary stent in a patient with venous thromboembolism or atrial fibrillation
Drug interactions:
- clinically significant bleeding up to 28% [2,3]
- major bleeding 4-5% [1]
Management:
- dual therapy with P2Y12 inhibitor + direct oral anticoagulant as effective for reducing thromboembolic events with less risk of bleeding [2,3]
Properties
DRUGS: aspirin
P2Y12-receptor inhibitor
anticoagulant
References
- Fiedler KA et al.
Duration of triple therapy in patients requiring oral
anticoagulation after drug-eluting stent implantation:
The ISAR-TRIPLE trial.
J Am Coll Cardiol 2015 Apr 28; 65:1619
PMID: 25908066
- Link MS
Which Anticoagulation Strategy for Patients with Atrial
Fibrillation and a New Stent?
NEJM Journal Watch. Nov 14, 2016
Massachusetts Medical Society
(subscription needed) http://www.jwatch.org
- Gibson CM, Mehran R, Bode C et al.
Prevention of bleeding in patients with atrial fibrillation
undergoing PCI.
N Engl J Med 2016 Nov 14
PMID: 27959713
http://www.nejm.org/doi/10.1056/NEJMoa1611594
- Cannon CP, Bhatt DL, Oldgren J, et al.
Dual antithrombotic therapy with dabigatran after PCI in atrial
fibrillation.
N Engl J Med 2017; 377:1513-1524. October 19, 2017
PMID: 28844193
http://www.nejm.org/doi/10.1056/NEJMoa1708454