Antithrombotic Treatment of Stable Coronary Artery Disease

Abstract

Coronary artery disease (CAD) is one of the leading causes of death in Taiwan. Despite the use of current guideline-recommended therapies for secondary prevention, the residual risk of recurrent cardiovascular events remains high in CAD, warranting the need for new treatment options. Antithrombotic drugs are one of the most important medical therapies for CAD. In this article, we review the unmet needs of the current antithrombotic agents and summarize the results of clinical trials with dual antiplatelet therapy in stable CAD. We also review data from a recent study demonstrating the benefits of a dual pathway inhibition strategy with antiplatelet and anticoagulant therapy, a new option for CAD treatment. Finally, we propose a treatment algorithm for choosing different antithrombotic regimens for CAD based on current scientific evidence and expert opinions.

Keywords: Antithrombotics; Coronary artery disease; Dual antiplatelet therapy; Dual pathway inhibition.

Figure 1

An algorithm of choosing antithrombotic therapy for patients with coronary artery disease not requiring full dose oral anticoagulation. The criteria to define high bleeding risk and high ischemic risk are described in Table 2. Patients are considered to have low risk if they do not have high risk features. ACS, acute coronary syndrome; CAD, coronary artery disease; DAPT, dual antiplatelet therapy; DPI, dual pathway inhibition; NSTEMI, non-ST elevation myocardial infarction; PAD, peripheral artery disease; PCI, percutaneous coronary intervention; SAPT, single antiplatelet therapy; STEMI, ST-elevation myocardial infarction; UA, unstable angina.