Due to changes within the CCS Guidelines the Triple Therapy Guide is currently unavailable as we complete updates. Please check back soon.

About This Website

Prescribing an ideal antithrombotic regimen following coronary stenting / acute coronary syndrome plus atrial fibrillation, requires careful consideration of the delicate balance between the risk of hemorrhage and the risk of thrombosis. We created this tool to help you design an individualized antithrombotic regimen according to the updated Canadian Cardiovascular Society guidelines, which takes into account both the medical interventions applied, and individual patient factors and comorbidities.

Printable Instructions

This tool will generate a printable discharge instruction sheet outlining the antiplatelet and anticoagulation agents, their indication and precise dosing and ranges of therapy duration, which can then be distributed to the patient, the referring physician and the pharmacist.

Patient Profile
Sex:
Medical Conditions
ACS:
Recent Procedure:
High Risk Features:
Recent Stent(s):
Pre-Existing Condition (select all that apply):
Previous Stroke or TIA or Systemic Arterial Embolism:
High Bleeding Risk:
Is there any chance this patient could be pregnant:
Medication Allergies:
Patient Medication
ASA:
P2Y12 Inhibitors:
Anticoagulants:

Your Blood Thinning Medications Following Discharge

Prepared 2023-06-01
Name:
PIN:

Physician's Name:
Physician's Contact:

This document outlines your medication and dosage for the next year. Return for a follow-up appointment on 2024-06-01 to consult for your medication after this date.

Recommendations

This guideline-directed prescribing algorithm uses guidelines and recommendations published primarily by the Canadian Cardiovascular Society. This tool is designed primarily for common clinical scenarios, and to aid in the organization of complex prescriptions. The recommendations provided may not always be appropriate for your patient, particularly in complicated clinical scenarios where individual factors must be considered. We do not provide medical advice; clinical judgement is required to ensure safe and accurate prescriptions. While information in our algorithm is obtained from sources that are generally regarded as reliable, medical information changes rapidly and we do not guarantee accuracy of our recommendations. Please be sure to review the information carefully before prescribing the guideline-directed dosing regimen. We do not assume any liability or responsibility for damage or injury to any patient or physician arising from the use of this clinical tool.

Details
Medication: Dose and Timeline:
CCS Guidelines
CCS Guidelines

Recommendations to be generated after filling out the forms.
Notes and Directions
Notes and Directions

Visit tripletherapyguide.com/src/patient-faqs for a full list of commonly asked questions.

What is the purpose of blood-thinners in heart disease?

  • Blood thinners prevent the development of a thrombus (blood clot) within the body
  • Once a thrombus forms, it can block various chambers or blood vessels and/or break off, becoming an embolism, where it can then travel through the blood stream and lodge in an artery elsewhere within the body (thrombo-embolism)
  • Specific types of blood thinners are indicated for specific reasons
  • Hence one or more categories of blood thinners may be required in certain situations
  • The benefit of using blood thinners (reducing clotting) must always be balanced with risks (bleeding).

Why do I need to take blood thinners after my procedure?

  • There are two types of blood thinners: antiplatelets and anticoagulants. Depending on your individual factors and the procedure you had, you may have to take a combination of these medications. These medications help to make your blood less sticky, preventing it from forming clots. Blood clots can be dangerous, as they can stop the blood from flowing, potentially leading to a heart attack or stroke.

What are the different types of blood thinners used in heart disease?

  • Oral Anti-Coagulants (OAC) – pills taken by mouth to reduce formation of fibrin (mesh) within the blood
    • Warfarin (Coumadin) – requires regular blood tests, which measure how long it takes your blood to clot (INR) . Dose varies according to INR value.
    • NOAC (or DOAC) means novel or direct oral anticoagulant– consists of once or twice daily pills that do not require frequent monitoring e.g. apixaban, edoxaban, rivaroxaban and dabigatran
  • Injectable/Intravenous Blood-Thinners
    • used in hospital in emergency situations
    • occasionally injectable agents used out-of-hospital (low moleculer weight heparin – e.g.. Dalteparin, Enoxaparin)
  • Anti-Platelet Therapy (APT) – prevent “sticky platelets” from forming clot
    • Aspirin (ASA)
    • P2Y12 Blockers (Clopidogrel, Ticagrelor, Prasugrel)
    • Dipyridamole (persantine)
  • Combination Therapy
    • Blood thinners are very specific; certain blood thinners protect against clotting in specific circumstances and in certain situations combination therapy is necessary
    • ASA may be combined with a P2Y12 Blocker
    • ASA and/or a P2Y12 blocker may be combined with an OAC
    • If atrial fibrillation is present and a stent has been inserted into a coronary artery, then a combination of anti-platelet medication (P2Y12 Inhibitor +/- Aspirin) will be needed for stent protection, and a Novel Oral Anti-Coagulant (eg. NOAC) may be necessary for the Atrial Fibrillation
    • Duration of the anti-platelet medication will vary based on individual factors

What are the signs and symptoms of stroke?

  • FACE is it drooping?
  • ARMS can you raise both?
  • SPEECH is it slurred or jumbled?
  • TIME to call 9-1-1 right away

Call 911 immediately if you experience any of these signs/symptoms

Act because the quicker you act, the more of the person you save.

What are the signs and symptoms of a heart attack?

  • Call 911 immediately if you experience any of these signs/symptoms
  • Chest Discomfort (pressure, squeezing, fullness or pain, burning or heaviness)
  • Upper Body Discomfort (neck, jaw, shoulder, arms back)\
  • Sweating
  • Shortness of Breath
  • Light-Headedness
  • The most common sign is chest pain or discomfort in men and women
  • Women can experience a heart attack without chest pressure
  • Women may experience:
    • Pressure/ pain in lower chest or upper abdomen
    • Dizziness/ Light-Headedness/ Fainting
    • Upper Back Pressure
    • Extreme Fatigue

What are the signs and symptoms of bleeding ?

  • If you experience any of these signs, see prompt medical attention or call 911
  • Symptoms of stroke
  • Sudden severe headache and/or neck stiffness
  • Confusion
  • Dizzy, vertigo (spinning sensation)
  • Faint or lightheaded
  • Confusion
  • Loss or blurry vision
  • Shortness of breath
  • Low blood pressure and/or fast heart rate
  • Bloody or black (tarry) stools
  • Vomiting blood or coffee-like material
  • Coughing up blood
  • Blood in urine
  • Pain, swelling, reduced motion in a major joint
  • Swelling and major bruising such as thigh, arm or abdominal wall
  • Sudden pain in the chest, abdomen, flank or back
  • Bleeding that doesn’t stop with compression such as a nosebleed

What can I do to reduce the risk of bleeding?

  • Take medications as prescribed
  • Maintain regular medical follow-up (in the case of warfarin, your doctor will arrange for regular blood tests to monitor INR)
  • Ensure blood pressure is well-controlled
  • Avoid anti-inflammatory medication (unless prescribed by a doctor)
  • Any new medication should be confirmed with your doctor and pharmacist to ensure no adverse interaction with blood thinners
  • Caution about over-the-counter medicines or herbal supplements that have effect on blood thinning (e.g. tumeric, garlic, ginkgo biloba). Check with a pharmacist to be certain
  • Limit or avoid alcohol (or at least excessive or binge drinking). Maximum 1 oz spirits, 12 oz. beer or 1 glass wine per day if you do drink.
  • Notify doctor if any dental or medical or surgical procedures are scheduled
  • Caution or avoidance of activities at high risk of falling or trauma
  • Recognize the signs/ symptoms of bleeding
  • See special precautions for those taking warfarin

What do I do if I am scheduled for a procedure or operation after discharge?

  • Ensure your cardiac specialist, doctor or dentist doing the procedure is aware of your heart condition and medications – especially blood thinners
  • In some cases of minor procedures the blood thinners can be continued, but in more invasive surgery they may need to be stopped (the specialist and cardiologist should be informed and provide guidance on any alteration of dosing, when to stop and resume after the procedure)
  • Occasionally an injectable anticoagulants may be used for a few days when warfarin is temporarily discontinued to reduce the risk of clotting under the guidance of your physician
  • Certain dental and medical procedures and surgery may require a dose of antibiotic (usually pills) to be taken before the operation to protect against infection (especially those with artificial heart valves, certain congenital heart defects, transplanted hearts and other heart devices). Coronary stents, in most cases, alone do not require such antibiotic coverage.
Create your own recommendations