1 Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Meta-analysis of the combination of warfarin and dual antiplatelet therapy after coronary stenting in patients with indications for chronic oral anticoagulation REFERENCES. Dans AL, Connolly SJ, Wallentin L, et al. Concomitant use of antiplatelet therapy with dabigatran or warfarin in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial. As a result, the ACC/AHA guidelines recommend oral anticoagulant therapy with warfarin for those patients with at least 1 additional risk factor for stroke and suggest the use of aspirin only for those at low risk for stroke such as patients without risk factors. Dual antiplatelet therapy (DAPT) is the standard of care to reduce. Dual antiplatelet therapy with aspirin and clopidogrel has been proven to be beneficial in patients with either non–ST-segment elevation (NSTE) ACS, ST-segment elevation MI (STEMI), and in. To identify factors associated with the use of single or dual antiplatelet therapy in patients prescribed warfarin following coronary stenting and to investigate whether single (aspirin or thienopyridine) vs. dual antiplatelet therapy plus warfarin leads to an excess of adverse outcomes. Triple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this. While current European guidelines recommend oral anticoagulation treatment over antiplatelet therapy for the prevention of ischaemic stroke in patients with non-valvular atrial fibrillation (AF) with a 64% stroke risk reduction by warfarin treatment versus placebo and a 39% risk reduction versus aspirin,1 single or dual antiplatelet therapy is. tion for warfarin therapy (e.g. atrial fibrillation) who also have an indication for antiplatelet therapy (e.g. coronary artery disease) but the appropriateness of such an approach is unresolved. Anticoagulation appears to be as effective as antiplatelet therapy for long-term management of acute coronary syndrome and stroke, and possibly peripheral artery disease, but causes more bleeding. Potential Strategies to Minimize Hemorrhagic Complications. Consistent risk factors for major hemorrhage on warfarin include older age, anticoagulation intensity, early course of therapy, prior bleed, and concomitant antiplatelet therapy. Additional risk factors for ICH include prior stroke and hypertension.