The Combination of Oral Anticoagulant and Antiplatelet Therapies: Stay One Step Ahead

F. Luca*, S. Giubilato, S.A. Di Fusco, A. Leone, S. Poli, C.M. Rao, A. Iorio, S. Gelsomino, D. Gabrielli, F. Colivicchi, L. De Luca, M.M. Gulizia

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Citations (Web of Science)

Abstract

Antithrombotic drugs, which include antiplatelets and anticoagulants, are effective in prevention and treatment of many cardiovascular disorders such as acute coronary syndromes, stroke, and venous thromboembolism and are among the drugs most commonly prescribed worldwide. The advent of direct oral anticoagulants, which are safer alternatives to vitamin K antagonists and do not require laboratory monitoring, has revolutionized the treatment of nonvalvular atrial fibrillation and venous thromboembolism. The combination of oral anticoagulant and antiplatelet therapy is required in many conditions of great clinical impact such as the coexistence of atrial fibrillation and coronary artery disease, with indication to percutaneous coronary intervention. However, strategies that combine anticoagulant and antiplatelet therapies lead to a significant increase in bleeding rates and it is crucial to find the right combination in the single patient in order to optimize the ischemic and bleeding risk. The aim of this review is to explore the evidence and controversies regarding the optimal combination of anticoagulant and antiplatelet therapy through the consideration of past dogmas and new perspectives from recent clinical trials and to propose a tailored therapeutic approach, according to specific clinical scenarios and individual patient characteristics. In particular, we separately explored the clinical settings of stable and acute coronary syndromes and percutaneous revascularization in patients with atrial fibrillation.
Original languageEnglish
Article number1074248420923528
Pages (from-to)391-398
Number of pages8
JournalJournal of Cardiovascular Pharmacology and Therapeutics
Volume25
Issue number5
DOIs
Publication statusPublished - 1 Sep 2020

Keywords

  • acute coronary syndromes
  • anticoagulant therapy
  • antiplatelet therapy
  • antithrombotic regimen
  • aspirin
  • atrial fibrillation
  • atrial-fibrillation patients
  • coronary artery disease
  • dabigatran
  • doacs
  • double-blind
  • intervention
  • myocardial-infarction
  • rivaroxaban
  • triple therapy
  • DOACs
  • RIVAROXABAN
  • ASPIRIN
  • TRIPLE THERAPY
  • INTERVENTION
  • MYOCARDIAL-INFARCTION
  • ACUTE CORONARY SYNDROMES
  • ATRIAL-FIBRILLATION PATIENTS
  • DABIGATRAN
  • DOUBLE-BLIND
  • ANTITHROMBOTIC REGIMEN

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