Heart entangled in medications, balancing dual and triple therapy.

Dual vs. Triple Therapy After PCI: What's Best for Your Heart?

Lena Kashyap in Health & Wellness July 2025 • 4 min read.

"New research sheds light on the optimal antithrombotic treatment after percutaneous coronary intervention (PCI), particularly for patients on oral anticoagulants."

If you're undergoing percutaneous coronary intervention (PCI) and require oral anticoagulation (OAC), you might be wondering about the best antithrombotic therapy. Balancing the risk of blood clots and bleeding is crucial, and guidelines often recommend triple antithrombotic therapy (TAT)—combining an OAC with dual antiplatelet treatment (aspirin and another antiplatelet drug).

However, TAT increases bleeding risk, leading some to consider dual antithrombotic therapy (DAT) that omits aspirin. While existing data is conflicting, a recent study offers insights into the effectiveness and safety of DAT versus TAT in real-world patients.

This article explores the findings of this study, helping you understand the potential benefits and risks of each approach, especially if you're among the growing number of individuals requiring OAC and undergoing PCI.

DAT vs. TAT: What the Research Says

Heart entangled in medications, balancing dual and triple therapy.

Researchers analyzed data from 237 patients undergoing PCI with either a drug-eluting stent (DES) or a bioresorbable vascular scaffold (BVS). All patients required OAC. The study compared the outcomes of those receiving DAT (a P2Y12 receptor inhibitor like clopidogrel plus OAC) with those receiving TAT (aspirin, a P2Y12 receptor inhibitor, and OAC).

The primary outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCE)—a composite of death, myocardial infarction (MI), stroke, or stent thrombosis—within one year of PCI.

The study found that MACCE occurred significantly more often in the DAT group (18%) compared to the TAT group (7.4%).
Multivariable analysis confirmed that DAT was independently associated with a higher risk of MACCE.
Specifically, DAT was linked to higher rates of myocardial infarction and death.
Major bleeding rates did not differ significantly between the two groups.

These findings suggest that, in this patient population, omitting aspirin (DAT) may not be the optimal strategy for preventing adverse cardiovascular events. However, it's important to delve deeper into the specifics of the study to understand its implications fully.

The Bottom Line: What This Means for You

This study indicates that dual antithrombotic therapy (DAT) without aspirin may be associated with a higher risk of adverse cardiovascular events compared to triple antithrombotic therapy (TAT) in patients undergoing PCI who also require oral anticoagulation. However, this is just one study, and more research is needed.

The decision regarding which antithrombotic therapy is best for you should be made in close consultation with your cardiologist. They will consider your individual risk factors for both clotting and bleeding, as well as the specific details of your PCI procedure and overall health.

Ongoing clinical trials are exploring different combinations of anticoagulants and antiplatelet agents. As new evidence emerges, treatment strategies will continue to evolve, with the ultimate goal of optimizing both safety and effectiveness for each patient.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1002/ccd.27678, Alternate LINK

Title: Real Clinical Experiences Of Dual Versus Triple Antithrombotic Therapy After Percutaneous Coronary Intervention

Subject: Cardiology and Cardiovascular Medicine

Journal: Catheterization and Cardiovascular Interventions

Publisher: Wiley

Authors: Isabel Wustrow, Nikolaus Sarafoff, Bernhard Haller, Lisa Rössner, Dirk Sibbing, Stefanie Schüpke, Tareq Ibrahim, Aida Anetsberger, Heribert Schunkert, Karl‐Ludwig Laugwitz, Adnan Kastrati, Isabell Bernlochner

Published: 2018-07-18

Everything You Need To Know

After PCI, why is there a choice between dual and triple antithrombotic therapy?

Following percutaneous coronary intervention (PCI) and the need for oral anticoagulation (OAC), guidelines often suggest triple antithrombotic therapy (TAT), a combination of OAC, aspirin, and another antiplatelet drug. Dual antithrombotic therapy (DAT) involves omitting aspirin. The core decision revolves around balancing the risks of blood clots against the risk of bleeding, a complex challenge that this study aimed to address.

What exactly did the researchers compare regarding antithrombotic therapies?

This research compared dual antithrombotic therapy (DAT), using a P2Y12 receptor inhibitor such as clopidogrel along with oral anticoagulation (OAC), against triple antithrombotic therapy (TAT), which includes aspirin, a P2Y12 receptor inhibitor, and OAC. The study evaluated the occurrence of major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction (MI), stroke, or stent thrombosis, within one year post-PCI.

What were the main outcomes observed when comparing DAT and TAT?

The study indicated that major adverse cardiac and cerebrovascular events (MACCE) occurred more frequently in the dual antithrombotic therapy (DAT) group (18%) compared to the triple antithrombotic therapy (TAT) group (7.4%). Multivariable analysis supported that DAT was independently associated with a heightened risk of MACCE, specifically higher rates of myocardial infarction and death. Interestingly, major bleeding rates were similar in both groups.

What are the implications of these findings for someone who has PCI and needs oral anticoagulation?

The study suggests that dual antithrombotic therapy (DAT) without aspirin may not be the best approach for preventing adverse cardiovascular events in patients undergoing PCI who also require oral anticoagulation (OAC). However, since this is just one study, more research is necessary to validate these findings and refine treatment guidelines. Factors such as individual patient risk profiles, the specific type of stent used (DES or BVS), and other clinical considerations should also be taken into account.

What aspects of antithrombotic therapy following PCI were not addressed in this study?

While the study provided valuable insights into comparing dual antithrombotic therapy (DAT) and triple antithrombotic therapy (TAT) after PCI in patients needing oral anticoagulation (OAC), it did not delve into specifics such as the duration of each therapy, the impact of different P2Y12 inhibitors, or variations in OAC dosing. Future research could explore these variables, as well as assess outcomes beyond one year and investigate the role of newer antiplatelet agents. Additionally, personalized approaches based on genetic factors influencing drug response could further refine antithrombotic strategies.