Updated antithrombotic strategies to reduce the burden of cardiovascular recurrences in patients with chronic coronary syndrome

• Published in: Biomedicine & pharmacotherapy Vol. 140; p. 111783
• Main Authors: Patti, Giuseppe, Fattirolli, Francesco, De Luca, Leonardo, Renda, Giulia, Marcucci, Rossella, Parodi, Guido, Perna, Gian Piero, Andreotti, Felicita, Ghiglieno, Chiara, Fedele, Francesco, Marchionni, Niccolò
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.08.2021; Elsevier
• Subjects: Antithrombotic therapy; Bleeding; Chronic coronary syndrome; Myocardial infarction; Myocardial infarction; Chronic coronary syndrome; Antithrombotic therapy; Bleeding
• ISSN: 0753-3322; 1950-6007
• DOI: 10.1016/j.biopha.2021.111783

Despite recent achievements in secondary cardiovascular prevention, the risk of further events in patients with chronic coronary syndromes (CCS) remains elevated. Highest risk is seen in patients with recurrent events, comorbidities or multisite atherosclerosis. Optimising antithrombotic strategies in this setting may significantly improve outcomes. The higher the baseline risk, the higher the absolute event reduction with approaches using combined antithrombotic treatments. Tailoring such strategies to the individual patient risk appears crucial to achieve net benefit (i.e., substantial ischaemic event prevention at a limited cost in terms of bleeding). This paper focuses on antithrombotic and non-pharmacological approaches to secondary cardiovascular disease prevention in CCS. In particular, we critically review current evidence on the use of dual antithrombotic therapy, including the newest approach of aspirin plus low-dose anticoagulation and its net clinical outcome according to baseline risk. •The risk of recurrent events remains high in patients with CCS.•Antithrombotic approaches are SAPT or DAPT or low-dose rivaroxaban plus aspirin.•An antithrombotic approach tailored to both ischaemic and bleeding risk is crucial.•Healthy lifestyle and risk factor control further decrease recurrent events.