Long-term residual cardiovascular risk after acute coronary syndrome: antithrombotic treatment options

D. R. P. P. Chan Pin Yin, J.M. ten Berg*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

3 Citations (Web of Science)

Abstract

The residual risk of patients surviving until 1 year after acute coronary syndromes (ACS) is still high, despite secondary prevention. The cornerstone of treatment of patients with ACS is dual antiplatelet therapy (DAPT) consisting of low-dose aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) for 12 months, or less in those patients at higher risk for bleeding. To reduce the residual risk beyond 1 year in those patients not at high bleeding risk who tolerated DAPT and did not suffer an (ischaemic or bleeding) event would intuitively mean to prolong DAPT. However, prolonged DAPT always comes at the cost of more bleeding. Therefore, assessing both ischaemic and bleeding risk in these patients at 1 year after ACS is crucial. In addition, another antithrombotic treatment consisting of low-dose rivaroxaban combined with low-dose aspirin has been shown to reduce ischaemic events. In this review, we describe residual thrombotic risk at 1 year after ACS, evaluate the evidence for antithrombotic options beyond 1 year and provide a practical guide to determine which patients would benefit the most from these therapies.
Original languageEnglish
Pages (from-to)38-46
Number of pages9
JournalNetherlands Heart Journal
Volume30
Issue number1
Early online date6 Aug 2021
DOIs
Publication statusPublished - Jan 2022

Keywords

  • Acute coronary syndrome
  • Antithrombotic therapy
  • Ischaemic risk
  • Myocardial infarction
  • DUAL-ANTIPLATELET THERAPY
  • MYOCARDIAL-INFARCTION
  • SECONDARY PREVENTION
  • STENT IMPLANTATION
  • COST-EFFECTIVENESS
  • BLEEDING RISKS
  • ARTERY-DISEASE
  • RIVAROXABAN
  • TICAGRELOR
  • DURATION

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