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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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