Antithrombotic dilemma.

Karjalainen PP, Porela P, Ylitalo A et al.: Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting. Eur. Heart J. 28(6), 726-732 (2007). Chronic oral antithrombotic treatment is necessary in patients with mechanical heart valves and in the majority of patients with atrial fibrillation. Many of these patients also have ischemic heart disease. When these patients are required to undergo percutaneous coronary intervention with stenting, there is also an indication for treatment with aspirin and clopidogrel. However, triple therapy is known to augment the risk for bleeding complications. It is therefore unknown what the best antithrombotic treatment is, when considering both thrombotic (e.g., stent thrombosis) and bleeding complications. Unfortunately, no prospective (randomized) data are available to solve this issue.