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This is a combination therapy consisting of three pharmacological agents: - **Warfarin** is an oral anticoagulant that acts as a vitamin K antagonist, inhibiting the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) in the liver. It is primarily used for the prevention and treatment of thromboembolic disorders such as atrial fibrillation and venous thromboembolism. - **Acetylsalicylic acid** (aspirin) is an antiplatelet agent that irreversibly inhibits cyclooxygenase-1 (COX-1), thereby reducing thromboxane A2 production and platelet aggregation. It is commonly used for secondary prevention of cardiovascular events. - **Proton pump inhibitor** (PPI) refers to any drug in this class (e.g., omeprazole, pantoprazole), which suppresses gastric acid secretion by irreversibly inhibiting the H+/K+ ATPase enzyme in gastric parietal cells. PPIs are co-prescribed to reduce gastrointestinal bleeding risk associated with antithrombotic therapies. This triple therapy regimen may be indicated in patients at high risk for both thrombosis and gastrointestinal bleeding—such as those with atrial fibrillation who have undergone percutaneous coronary intervention or have concomitant vascular disease. However, it significantly increases bleeding risk compared to monotherapy or dual therapy; thus, careful patient selection and monitoring are required[1][3][5][7].
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