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A Focus on Pharmacotherapy
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This issue we explore two of the most debated topics in interventional cardiology today: triple therapy with oral anticoagulants and pretreatment with antiplatelet therapy.
In the cover story, experts examine the current state-of-play for the use of oral anticoagulants in the setting of triple therapy among patients with atrial fibrillation also undergoing PCI, as well as the many remaining questions that data have yet to elucidate. On the top of the list is how to incorporate the recently FDA-approved anticoagulants — apixaban (Eliquis, Bristol-Myers Squibb/Pfizer), dabigatran (Pradaxa, Boehringer Ingelheim) and rivaroxaban (Xarelto, Janssen Pharmaceuticals) — into this setting. Despite each of these drugs having their advantages compared with warfarin, the lack of data and guidance have left physicians with more questions than answers.
“The common practice [with triple therapy] has been to use some combination of aspirin, clopidogrel and warfarin. But if we now include the newer antiplatelet agents … and the newer anticoagulants, you can imagine the multitude of combinations that are possible,” said Duane Pinto, MD, MPH, associate professor at Harvard Medical School, Boston, and Cardiology Today’s Intervention Editorial Board member. “At this point, the efficacy of each of these different combinations is not well studied.”
In an effort to help clinicians make the best possible choices for their patients, sources interviewed provide insight on how they handle this complex dilemma and discuss the upcoming data that may provide some much-needed answers.
Similarly, in the feature, experts from the United States and Europe offer their thoughts on pretreatment with antiplatelet therapy in patients with MI expected to undergo PCI, sharing highlights from the latest data as well as their own clinical preferences. According to those interviewed, pretreatment seems more likely to benefit patients with STEMI than patients with non-STEMI or stable CAD.
So, how do you manage patients with AF also undergoing PCI? Is pretreatment part of your practice and, if so, which patients do you pretreat? Please send any and all responses to me at the email address below. I look forward to hearing from you and sharing your thoughts with our readers.
– Brian Ellis
Managing Editor, Cardiology Today’s Intervention
bellis@slackinc.com