Haley M. Phillippe, PharmD, BCPS Auburn University Harrison School of Pharmacy, University of Alabama Birmingham School of Medicine–Huntsville mccrahl@auburn.edu
Sharon R. Baty, PharmD Huntsville Hospital, Huntsville, Ala
Candace B. Griffith, PharmD Enteral/ Parenteral Pharmacy, Huntsville, Ala
The authors reported no potential conflict of interest relevant to this article.
Before limiting a patient’s thienopyridine therapy to one month, consider his or her risk of reinfarction. If it is high, continuing the thienopyridine for at least one year is likely to provide the most benefit.
FAST TRACK
In clinical trials, triple therapy significantly reduced the incidence of major adverse cardiac events, including death, but significantly increased the risk of bleeding.
The largest triple therapy trial to date compared the efficacy of triple therapy vs dual therapy (a single antiplatelet agent plus warfarin) in patients with ACS and an indication for warfarin therapy.3 This trial found no statistically significant differences in the combined occurrence of death, stroke, unscheduled PCI, and MI between the 2 treatment groups. (Bleeding risk was not evaluated.) Stroke was significantly increased in the group that received therapy with warfarin and a single antiplatelet agent, with this caveat: The occurrence of stroke was so low overall that no conclusions could be reached from this difference.3
One problem with this trial, and with others evaluating triple therapy, has to do with the lack of consistency, as well as the duration. The warfarin and single antiplatelet group, for example, may have included patients who were receiving only warfarin, aspirin, or clopidogrel by 6 months after initiating treatment.3 Thus, although reinfarction or stent thrombosis after ACS or PCI-S typically occurs within the first few months, any triple therapy trial that lasts less than a year is likely to report skewed results. JFP
CORRESPONDENCE Haley M. Phillippe, PharmD, BCPS, Auburn University Harrison School of Pharmacy, University of Alabama Birmingham School of Medicine?Huntsville, 301 Governors Drive, Huntsville, AL 35801; mccrahl@auburn.edu
