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The article by Buresly and colleagues¹ adds valuable information about the safety of combining aspirin with thienopyridine derivatives and/or warfarin in elderly patients receiving routine clinical care. Three points are relevant and complementary to the data presented in their study.

First, I could locate only 1 other publication that addresses the use of the 3-drug combination of aspirin, clopidogrel, and warfarin in a nontrial setting.² This study evaluated outcomes in 66 patients who were given the 3-drug combination following percutaneous coronary intervention with stent placement. Six of these patients had a bleeding event. Of the 6 bleeding events, 4 were serious enough to warrant hospital readmission.²

A second important issue is the need to balance the potential risks and benefits of antiplatelet therapy and anticoagulation for older adults. This remains a major challenge for clinicians. Therefore, in addition to comparing harms (bleeding events), future studies might also consider evaluating whether . . . [Full Text of this Article]

AUTHOR INFORMATION
Sudeep S. Gill, MD, MSc, FRCPC

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RELATED ARTICLE

Bleeding Complications Associated With Combinations of Aspirin, Thienopyridine Derivatives, and Warfarin in Elderly Patients Following Acute Myocardial Infarction
Khaled Buresly, Mark J. Eisenberg, Xun Zhang, and Louise Pilote
Arch Intern Med. 2005;165(7):784-789.
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