Investigation of the efficacy and safety issues of antithrombotic treatment in cardiovascular medicine

Abstract

Coronary artery disease (CAD) is the foremost single cause of mortality and loss of Disability Adjusted Life Years (DALYs) globally. A large number of this burden falls on low- and middleincome countries accounting for nearly 7 million deaths and 129 million DALYs annually. Antiplatelet therapy represents the cornerstone treatment and secondary prevention of CAD. Compared with placebo, antiplatelet therapy has been shown to reduce recurrent major adverse cardiovascular events (MACE) among patients with stable CAD or ACS. Patients with ACS undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) are currently recommended dual antiplatelet therapy (DAPT), consisting of aspirin with a P2Y12 receptor inhibitor for at least 12 months. The treatment goal is preventing thrombotic complications such as stent thrombosis. However, this strategy increases bleeding risk even in patients with a high thrombotic risk of ACS. Therefore, unresolved questions still remain in need of clarification. Non-valvular atrial fibrillation (NVAF) is the most commonly diagnosed heart rhythm abnormality. Anticoagulation is required for the prevention of thrombo-embolic complications related to NVAF. Over the past decade, novel direct oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban and edoxaban have become the treatment of choice in patients with NVAF over warfarin. However, estimates suggest that about 30% of patients with NVAF may have simultaneously CAD and 15% will require PCI with stent placement. The optimal antithrombotic regimen after PCI in patients with NVAF is still unclear. Identifying an optimal antithrombotic regimen to prevent bleeding and ischemic events presents an unmet challenge to physicians treating patients with NVAF.