Question 26#

A 75-year-old man with a previous history of persistent AF, peptic ulceration, and renal failure (creatinine 220 μmol/L) undergoes elective PCI to his LAD with a bare metal stent (BMS). He was on warfarin for AF prior to his PCI.
What is the best combination of drugs immediately following the procedure?

A) Aspirin, clopidogrel, and warfarin
B) Aspirin and clopidogrel
C) Aspirin and warfarin
D) Clopidogrel and warfarin
E) Warfarin alone

Correct Answer is A


This is a difficult question. This man has a HAS-BLED score of 3 (one point for each of age >65 years, renal failure, and bleeding predisposition), putting him at a high risk of bleeding. However, he also has a significant thromboembolic risk and antiplatelet drugs alone will not protect him from stroke. The ESC guidelines suggest that, ideally, he should have a BMS rather than a drug-eluting stent to reduce the duration of dual antiplatelets, but he will still require a minimum of 28 days triple therapy (2.6–4.6% risk of major bleed at 30 days). However, data now available for newer-generation drug-eluting stents support 3 months DAP only in some cases and so the risk of reintervention/restenosis is also relevant.