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Huda Salah Eldin: The Challenge of Balancing Antithrombotic Therapy After PCI
Huda Salah Eldin/LinkedIn
Sep 30, 2026, 13:41

Huda Salah Eldin: The Challenge of Balancing Antithrombotic Therapy After PCI

Huda Salah Eldin, Certified traineer in clinical pharmacy and critical care at Egyption health council at Egyption Health Council, shared a post on LinkedIn:

“One of the most challenging situations we faced in the CCU: balancing antiplatelet therapy and anticoagulation after PCI.

A patient with a recent myocardial infarction (MI) undergoes PCI with stent placement and requires dual antiplatelet therapy (DAPT).

But what if the patient also has an indication for long-term oral anticoagulation, such as atrial fibrillation (AF) or venous thromboembolism requiring extended treatment?

Combining these medications increases bleeding risk-making the choice and duration of therapy crucial.

The 2023 ESC guidelines for acute coronary syndromes outline an approach tailored to each patient’s ischaemic and bleeding risks:

 1.Initial phase: Triple therapy

  • Oral anticoagulant plus Clopidogrel plus Aspirin

The default duration is up to 1 week. This may be extended to 1 month when the risk of stent thrombosis outweighs the bleeding risk.

2.Next phase: Dual antithrombotic therapy

  • Stop Aspirin and continue Oral anticoagulant plus Clopidogrel.

Continue for up to 12 months after the acute event. A shorter duration may be considered in selected patients at high bleeding risk.

3.Beyond 12 months: Anticoagulation alone 

  • Discontinue Clopidogrel and continue the oral anticoagulant alone in most patients with an ongoing indication.

The goal is always to balance protection against stent thrombosis and thromboembolic events with the risk of bleeding.

An individualised treatment plan – and regular reassessment – makes all the difference.

Which factors most influence your decision about the duration of triple therapy in clinical practice?”

Huda Salah Eldin: The Challenge of Balancing Antithrombotic Therapy After PCI

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2023 ESC guidelines AF antithrombotic therapy Health Hematology Hemostasis Hemostasis News Hemostasis Today Huda Salah Eldin Medicine Myocardial infarction thrombosis
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