of Studies With Dual Therapy With Triple Therapy With Dual Antiplatelet Therapy With Triple Therapy CI) Quality of Evidence Burden of treatment (important outcome) N/A No serious limitations No serious limitations No serious limitations No serious limitations N/A N/A N/A Triple therapy . dual therapy Triple therapy: daily medication, lifestyle limitations, dietary restrictions, frequent blood testing and clinic visits High Dual antiplatelet therapy: daily medication only PLATO Study of Platelet Inhibition and Patient Outcomes; TIMI Thrombolysis In Myocardial Infarction. See Table legends for expansion of other abbreviations. a We used the relative risk for all-cause mortality, nonfatal MI, and nonfatal major extracranial bleeding associated with warfarin aspirin therapy vs aspirin alone in RCTs of patients with acute coronary syndrome (Rothberg et al ) to estimate the effect of triple therapy vs dual antiplatelet therapy on all-cause mortality in patients with AF and acute coronary syndrome. b The CI does not exclude important harm or bene t with triple therapy. c We used the same baseline estimates of mortality as for the general AF population receiving aspirin clopidogrel. This was based on data from Go et al, which reported a mortality rate of per person-y in untreated (no warfarin) patients from an observational study (ATRIA cohort), an estimated relative risk of for mortality with aspirin vs no therapy ( Table ), and an estimated relative risk of for mortality with aspirin clopidogrel vs aspirin ( Table ). d We used data from an RCT of warfarin vs aspirin clopidogrel in patients with AF (ACTIVE W) to estimate the relative effect of triple therapy vs dual antiplatelet therapy on nonfatal stroke and systemic embolism in patients with AF and acute coronary syndrome. This assumption may be underestimating the potential bene t of triple therapy vs dual antiplatelet therapy in reducing nonfatal stroke. 