ISAR-TRIPLE Antiplatelet Duration Algorithm

ISAR-TRIPLE Antiplatelet Duration Algorithm: clinical context and explanation The ISAR-TRIPLE randomized trial compared two durations of triple therapy (aspirin + clopidogrel + oral anticoagulant) in patients undergoing drug-eluting stent implantation who required chronic oral anticoagulation. At 9 months the composite primary endpoint (death, myocardial infarction, definite stent thrombosis, stroke, or TIMI major bleeding) did not differ significantly between the 6-week and 6-month clopidogrel strategies, indicating that a short (6-week) triple-therapy course is a reasonable option in many patients. Landmark analyses suggested lower bleeding after early discontinuation of clopidogrel, while ischemic event rates were low in both arms.

Therefore, for patients with DES who require OAC, a 6-week triple therapy strategy can be considered as default when bleeding risk is significant; conversely, features that raise ischemic risk (e.g., ACS presentation, prior stent thrombosis, mechanical valves/higher INR targets, complex PCI) may justify continuing triple therapy toward 6 months with close monitoring. Recent expert consensus and guideline documents have emphasized individualized strategies to minimize triple therapy duration and highlighted aspirin avoidance or early aspirin discontinuation (dual therapy strategies) in many OAC patients to reduce bleeding. Selected