Combining anticoagulation and antiplatelet drugs in coronary artery disease

Most patients with stable coronary disease are managed with a single antiplatelet drug. For those who require anticoagulation, an antiplatelet drug may not be required. Antiplatelet therapy for patients who have an acute coronary syndrome helps to prevent future cardiovascular events. This benefit can be increased by using two antiplatelet drugs. The choice of drug is determined for each individual patient. Factors to consider include whether the patient had a stent inserted, the risk of bleeding and whether they have another indication for anticoagulation. For patients without a stent, aspirin can be combined with a P2Y₁₂ antagonist for up to 12 months. Only one antiplatelet drug is recommended if the patient also needs long-term anticoagulation. Following stent insertion, patients with an indication for anticoagulation have been treated with two antiplatelet drugs and an anticoagulant. Recent research suggests that selected patients may be managed with one antiplatelet drug and an anticoagulant. After 12 months it may be possible to manage the patients with an anticoagulant alone.