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
Gill SS. Bleeding Complications in Elderly Patients Following Acute Myocardial Infarction. Arch Intern Med. 2005;165(20):2430–2431. doi:10.1001/archinte.165.20.2430-c
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