Transient Ischemic Attack in a High-Risk Cardiovascular Patient with Renal Dysfunction after Treatment with Rivaroxaban and Clopidogrel: A Case Report

Patients with atrial fibrillation who have experienced acute coronary syndrome that was treated with percutaneous coronary intervention (PCI) represent a challenge in antithrombotic management, in terms of balancing the risks of thrombosis and bleeding. The 2018 update of the Canadian Cardiovascular Society’s antiplatelet guidelines recommended triple therapy (an oral anticoagulant [OAC], a P2Y12 inhibitor, and acetylsalicylic acid [ASA]) with reduction in the intensity or dose of the OAC and consideration of dual therapy (OAC and P2Y12 inhibitor) within 1 day to 6 months after PCI following acute coronary syndrome.1 In contrast, the 2016 atrial fibrillation guidelines of the Canadian Cardiovascular Society recommend triple therapy for 3 to 6 months after PCI in patients with stroke risk defined by a CHADS65 score of 1 or greater.2 Triple therapy is associated with a 17.6% frequency of bleeding requiring hospitalization2; dual therapy has been proposed to reduce this risk of bleeding