A 91-year-old man with hypertension, chronic kidney disease, coronary artery disease, and congestive heart failure presented with chest pain. Electrocardiography revealed ventricular tachycardia. Given his hemodynamic stability, he was treated with intravenous amiodarone, converted to sinus rhythm, and the chest pain resolved. His cardiac troponin level was elevated, prompting urgent cardiac catheterization, which revealed a long lesion in the right coronary artery. This was stented with a 3.5 × 38-mm second-generation drug-eluting stent (DES), and the patient was initiated on dual antiplatelet therapy (DAPT) with aspirin, 81 mg daily, and clopidogrel, 75 mg daily. Warfarin was subsequently added for newly discovered atrial fibrillation (target international normalized ratio [INR], 2.0-3.0).
Nouri SN, Block BL. Triple Oral Antithrombotic TherapyA Teachable Moment. JAMA Intern Med. 2016;176(10):1433-1434. doi:10.1001/jamainternmed.2016.4415