CC BY 4.0 · Thromb Haemost 2019; 19(10): 1583-1589
DOI: 10.1055/s-0039-1679903
Theme Issue Article
Georg Thieme Verlag KG Stuttgart · New York

Dual Antiplatelet or Dual Antithrombotic Therapy for Secondary Prevention in High-Risk Patients with Stable Coronary Artery Disease?

Wael Sumaya
1  Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
,
Tobias Geisler
2  Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany
,
Steen D. Kristensen
3  Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Robert F. Storey
1  Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
› Author Affiliations
Funding W.S. was funded by British Heart Foundation Clinical Research Training Fellowship (FS/15/82/31824).
Further Information

Publication History

11 October 2018

10 January 2019

Publication Date:
05 March 2019 (eFirst)

  

Abstract

Antithrombotic treatment is a key component of secondary prevention following acute coronary syndromes (ACS). Although dual antiplatelet therapy is standard therapy post-ACS, duration of treatment is the subject of ongoing debate. Prolonged dual antiplatelet therapy in high-risk patients with history of myocardial infarction reduced the risk of recurrent myocardial infarction, stroke or cardiovascular death. Similarly, in patients with stable coronary artery disease, two-thirds of whom had a history of myocardial infarction, dual antithrombotic therapy with very-low-dose rivaroxaban and aspirin also resulted in improved ischaemic outcomes. In the absence of head-to-head comparison, choosing the most appropriate treatment strategy can be challenging, particularly when it comes to balancing the risks of ischaemia and bleeding. We aim to review the evidence for currently available antithrombotic treatments and provide a practical algorithm to aid the decision-making process.