Dual-pathway inhibition for secondary and tertiary antithrombotic prevention in cardiovascular disease

Davide Capodanno¹, Deepak L Bhatt², John W Eikelboom³, Keith A A Fox⁴, Tobias Geisler⁵, C Michael Gibson⁶, Jose Ramon Gonzalez-Juanatey⁷, Stefan James⁸, Renato D Lopes⁹, Roxana Mehran¹⁰, Gilles Montalescot¹¹, Manesh Patel⁹, P Gabriel Steg¹², Robert F Storey¹³, Pascal Vranckx¹⁴, Jeffrey I Weitz¹⁵, Robert Welsh¹⁶, Uwe Zeymer¹⁷, Dominick J Angiolillo¹⁸

Affiliations

¹ Division of Cardiology, C.A.S.T., P.O. 'G. Rodolico', Azienda Ospedaliero-Universitaria 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy.
² Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA.
³ Population Health Research Institute, Hamilton General Hospital and McMaster University, Hamilton, ON, Canada.
⁴ Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
⁵ Department of Cardiology and Angiology, University Hospital of Tübingen, Tübingen, Germany.
⁶ Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical, Harvard Medical School, Boston, MA, USA.
⁷ Cardiology Department, University Hospital, IDIS, CIBERCV, Santiago de Compostela, Spain.
⁸ Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
⁹ Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, NC, USA.
¹⁰ Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Pitié Salpêtrière Hôpital (AP-HP), Paris, France.
¹² Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris University, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France.
¹³ Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
¹⁴ Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, and Faculty of Medicine and Life Sciences at the University of Hasselt, Hasselt, Belgium.
¹⁵ Departments of Medicine and Biochemistry and Biomedical Sciences, McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
¹⁶ Cardiac Sciences Department, Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, AL, Canada.
¹⁷ Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, Germany.
¹⁸ Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA. dominick.angiolillo@jax.ufl.edu.

PMID: 31953535
DOI: 10.1038/s41569-019-0314-y

Review

Dual-pathway inhibition for secondary and tertiary antithrombotic prevention in cardiovascular disease

Davide Capodanno et al. Nat Rev Cardiol. 2020 Apr.

. 2020 Apr;17(4):242-257.

doi: 10.1038/s41569-019-0314-y. Epub 2020 Jan 17.

Authors

Affiliations

¹ Division of Cardiology, C.A.S.T., P.O. 'G. Rodolico', Azienda Ospedaliero-Universitaria 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy.
² Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA.
³ Population Health Research Institute, Hamilton General Hospital and McMaster University, Hamilton, ON, Canada.
⁴ Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
⁵ Department of Cardiology and Angiology, University Hospital of Tübingen, Tübingen, Germany.
⁶ Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical, Harvard Medical School, Boston, MA, USA.
⁷ Cardiology Department, University Hospital, IDIS, CIBERCV, Santiago de Compostela, Spain.
⁸ Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
⁹ Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, NC, USA.
¹⁰ Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Pitié Salpêtrière Hôpital (AP-HP), Paris, France.
¹² Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris University, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France.
¹³ Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
¹⁴ Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, and Faculty of Medicine and Life Sciences at the University of Hasselt, Hasselt, Belgium.
¹⁵ Departments of Medicine and Biochemistry and Biomedical Sciences, McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
¹⁶ Cardiac Sciences Department, Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, AL, Canada.
¹⁷ Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, Germany.
¹⁸ Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA. dominick.angiolillo@jax.ufl.edu.

PMID: 31953535
DOI: 10.1038/s41569-019-0314-y

Abstract

Advances in antiplatelet therapies for patients with cardiovascular disease have improved patient outcomes over time, but the challenge of balancing the risks of ischaemia and bleeding remains substantial. Moreover, many patients with cardiovascular disease have a residual risk of ischaemic events despite receiving antiplatelet therapy. Therefore, novel strategies are needed to prevent clinical events through mechanisms beyond platelet inhibition and with an acceptable associated risk of bleeding. The advent of non-vitamin K antagonist oral anticoagulants, which attenuate fibrin formation by selective inhibition of factor Xa or thrombin, has renewed the interest in dual-pathway inhibition strategies that combine an antiplatelet agent with an anticoagulant drug. In this Review, we highlight the emerging pharmacological rationale and clinical development of dual-pathway inhibition strategies for the prevention of atherothrombotic events in patients with different manifestations of cardiovascular disease, such as coronary artery disease, cerebrovascular disease and peripheral artery disease.

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References

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Dual-pathway inhibition for secondary and tertiary antithrombotic prevention in cardiovascular disease

Affiliations

Dual-pathway inhibition for secondary and tertiary antithrombotic prevention in cardiovascular disease

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical