Recommendation ID
CG172/3
Question
Is treatment with an oral anticoagulant, aspirin and clopidogrel preferable to treatment with an oral
anticoagulant and clopidogrel in people who have had an MI, have an indication for oral anticoagulation and are treated either medically, by primary PCI or by coronary artery bypass grafting surgery?
Any explanatory notes
(if applicable)
Why this is important:- Many people who have had an MI have indications for long-term treatment with both oral anticoagulants and combination antiplatelet drugs. Those with atrial fibrillation, mechanical heart valves or a history of pulmonary emboli are at high risk of stroke or thromboembolism and therefore need anticoagulation to prevent these events. It is well recognised that people receiving a combination of antiplatelet therapy and oral anticoagulation are at high risk of minor, major and fatal bleeding events. These outcomes are often recurrent and associated with hospitalisation, blood transfusion and interventional procedures. The evidence review found limited high-quality evidence to identify whether, in this population, treatment with triple therapy (an oral anticoagulant, plus dual antiplatelet therapy) or dual therapy (an oral anticoagulant plus clopidogrel) is more effective. The Guideline Development Group recognised that this question was important in an increasingly elderly population, who are more likely to have comorbidities and who are at a higher risk of bleeding.

Source guidance details

Comes from guidance
Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease
Number
CG172
Date issued
November 2013

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 19/12/2013