Use of Oral Anticoagulation in Patients Received Antiplatelet Agents

Long-term antiplatelet therapy is the standard of care for various clinical condition including secondary prevention after coronary, cerebrovascular, and peripheral arterial diseases. Continuous use of long term antiplatelet therapy is recommended on these patients since the absolute benefit of reduction of cardiovascular events with the use of antiplatelet agents is larger than absolute risk of increased serious bleeding complications induced by them.

Anticoagulant therapy, on the other hand, is the standard of care for stroke prevention in high risk atrial fibrillation patients and those patients with venous thromboembolism though the absolute risk/benefit profile of oral anticoagulant therapy has not been established well as compared to antiplatelet therapy.

Both antiplatelet and anticoagulant therapy reduced the risk of thrombotic events by paying the cost for increased bleeding complication. It is hard to predict the increase in bleeding complication when anticoagulant therapy is added on patients who were treated by long term antiplatelet therapy. Patients with coronary artery disease often underwent coronary stenting. Dual antiplatelet therapy with aspirin and P2Y₁₂ receptor inhibitors were known to reduce cardiovascular event even after a year. However, it is hard to predict whether the addition of anticoagulant therapy further reduce the risk of thrombotic events without extreme increase in thrombotic events or not.

Recently, a few clinical evidences are provided to consider the way physicians should treat these difficult patient populations. With expectation of additional evidences available to data, the priority of oral anticoagulant and antiplatelet agents in various clinical conditions will be discussed.