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Review
. 2025;32(3):321-327.
doi: 10.5603/cj.104821. Epub 2025 May 22.

Extended dual antithrombotic therapy in patients with chronic coronary syndrome - which agent should be added to aspirin?

Jacek Kubica  1   2   3 , Piotr Adamski  1 , Katarzyna Buszko  1 , Piotr Buszman  4   5 , Nader Elmasri  6 , Tomasz Fabiszak  1 , Jakub Foryś  7 , Robert Gajda  3   8 , Mariusz Gąsior  9   10 , Robert Gil  11 , Paweł Grzelakowski  12 , Tomasz Hajdukiewicz  13 , Miłosz Jaguszewski  14 , Adam Kern  15   16 , Wacław Kochmann  17 , Jacek Konarski  2 , Aldona Kubica  1   3 , Tobiasz Kudla  18 , Wiktor Kuliczkowski  19 , Aleksandra Kusińska-Czyczyło  18 , Ewa Laskowska  1 , Przemysław Magielski  20 , Piotr Michalski  1 , Krzysztof Milewski  21 , Natalia Mrzywka  2 , Piotr Niezgoda  22 , Małgorzata Ostrowska  1 , Maciej Piasecki  1   2 , Przemysław Podhajski  1 , Janusz Prokopczuk  18 , Jakub Ratajczak  1 , Alicja Rzepka-Cholasińska  1 , Grzegorz Skonieczny  23 , Giuseppe Specchia  24 , Łukasz Szarpak  25   26   27 , Paweł Szymański  28 , Małgorzata Topolska  29 , Julia M Umińska  1 , Marcin Ziółkowski  1 , Aleksander Żurakowski  30   31 , Eliano Pio Navarese  32
Affiliations
Review

Extended dual antithrombotic therapy in patients with chronic coronary syndrome - which agent should be added to aspirin?

Jacek Kubica et al. Cardiol J. 2025.

Abstract

According to the 2024ESC Guidelines for the management of chronic coronary syndromes dual antithrombotic treatment comprising aspirin and a second antithrombotic drug for extended long-term prevention should be considered in patients at increased ischemic risk without high bleeding risk. However, no clear indications regarding the choice of a second antithrombotic agent are provided. It was therefore decided to discuss the available evidence regarding this issue. The guidelines provided the number needed to treat (NNT) and the number needed to harm (NNH) for each proposed medication. However, the presented data are misleading and may result in unjustified therapeutic decisions. Due to the great impact of this document on clinical practice all data provided in this document should be carefully verified and commented regarding limitations.

Keywords: chronic coronary syndrome; clopidogrel; extended antithrombotic therapy; prasugrel; rivaroxaban; ticagrelor.

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Conflict of interest statement

Conflict of interest: Jacek Kubica: Principal Investigator of the ELECTRA-SIRIO 2 trial, speaker and/or advisory board fee from: Adamed, AstraZeneca, Boehringer Ingelheim, Novartis, Pfizer, Servier; Miłosz Jaguszewski: travel grants and/or speaker fee from: Biotronik, Abbott Vascular, Bayer, Boehringer Ingelheim, Pfizer, Sandoz, Polpharma, Egis, Servier, Astra Zeneca, Amgen, Berlin Chemie Menarini.

Figures

Central illustration
Central illustration
inconsistencies between the European Society of Cardiology Guidelines and the exact values of the number needed to treat (NNT) and number needed to harm (NNH) for each agent based on reference clinical studies
See this image and copyright information in PMC

References

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