Current Antithrombotic Treatments for Cardiovascular Diseases: A Comprehensive Review

Abstract

Antithrombotic therapies (ATT) play a pivotal role in the management of cardiovascular diseases, aiming to prevent ischemic events while maintaining a delicate balance with the patient's bleeding risk. Typically, ATT can be classified into antiplatelet and anticoagulant therapies. Their application spans a broad spectrum of cardiovascular conditions, ranging from ischemic heart disease to atrial fibrillation, encompassing venous thromboembolisms and innovative structural interventional cardiology procedures. The global burden of cardiovascular diseases is steadily increasing, often giving rise to overlapping clinical presentations. Accordingly, the adoption of combined pharmacological approaches becomes imperative, potentially disrupting the delicate equilibrium between ischemic and bleeding risk, thus leading to nuanced pharmacotherapeutic pathways. In this context, contemporary investigations strive to identify a convergence point that optimizes the duration of medical therapy while addressing the need for antithrombotic effects, especially in the context of ischemic heart disease. This review aims to comprehensively revisit the main antithrombotic strategies in cardiovascular diseases, with the intention of enhancing a systematic approach which is key for the effective clinical management of these patients. Also, the review will examine the most impactful studies that have established the groundwork for current scientific evidence, with acknowledgement of special populations. Finally, we will cast a gaze into the future of this dynamic and evolving research field, exploring forthcoming perspectives and advancements.

Keywords: anticoagulation therapy; antiplatelet therapy; antithrombotic treatments; bleeding risk; cardiovascular diseases; ischemic risk; risk-to-benefit ratio.

Fig. 1.

Main classes of antithrombotic agents and their mechanism of action. Antithrombotic therapies play a pivotal role in the management of major cardiovascular diseases, aiming to prevent ischemic events while maintaining a delicate balance with the patient’s bleeding risk. Typically, they can be classified into antiplatelet and anticoagulant therapies, both equally discernible in oral and parenteral ones. Given the steady increase in the global burden of cardiovascular diseases, the adoption of combined pharmacological approaches becomes imperative, always with the aim of preventing ischemic events while carefully balancing the inevitable bleeding risk for the treated patient. Factor IIa, activated coagulation factor II; Factor Xa, activated coagulation factor X; COX, cyclooxygenase; TX2, thromboxane A2; UFH, unfractioned heparin.