Triple antithrombotic therapy in patients undergoing percutaneous coronary intervention: balancing between ischemia and bleeding

We appreciate the commentary by Dr. Shah and colleagues (1) on our paper assessing the duration of triple antithrombotic therapy among patients undergoing percutaneous coronary interventions (PCI) (2). As pointed by the authors, antithrombotic management of patients who undergo PCI with stent implantation and have concomitant indication for long-term oral anticoagulation (OAC) is a common clinical dilemma. While a so-called triple therapy with a combination of dual antiplatelet therapy (DAPT) plus warfarin has been the standard of care in these patients, it results in a higher risk of bleeding compared with less intensive antithrombotic regimens (3). Between the Scylla of ischemic and atherothrombotic risk and the Charybdis of hemorrhage, the question regarding the optimal treatment in this challenging group of patients remains largely unanswered.