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Direct Oral Anticoagulants and Coronary Artery Disease: The Debacle of the Aspirin Era?

Abstract
Long-standing aspirin is the cornerstone to prevent recurrence of thrombotic events in patients with ischemic heart disease. However, clopidogrel, a more potent antiplatelet agent, is preferred over aspirin in targeted populations, including those with a high risk of gastrointestinal bleeding. In addition, clopidogrel offers superior oral tolerance, and it may reduce the rates of intracranial hemorrhages compared with aspirin. However, an extensive inhibition of the coagulation cascade seems to be reasonable to minimize thrombotic events in such patients. After several failed exploratory investigations in the past with vitamin K antagonists, the newest direct oral anticoagulants may represent an alternative. To counterbalance bleeding complications, a low dose of these agents should be considered. Few publications have already showed promising results with the combination of clopidogrel and low-dose direct oral anticoagulants. Further investigations should be addressed to elucidate whether this is the downfall of the aspirin era for secondary prevention of atherosclerotic cardiovascular events.
AuthorsÁlvaro García-Ropero, Ariana P Vargas-Delgado, Carlos G Santos-Gallego, Juan J Badimon
JournalJournal of cardiovascular pharmacology (J Cardiovasc Pharmacol) Vol. 75 Issue 4 Pg. 269-275 (04 2020) ISSN: 1533-4023 [Electronic] United States
PMID31923049 (Publication Type: Journal Article, Review)
Chemical References
  • Factor Xa Inhibitors
  • Platelet Aggregation Inhibitors
  • Aspirin
Topics
  • Administration, Oral
  • Animals
  • Aspirin (administration & dosage, adverse effects)
  • Blood Coagulation (drug effects)
  • Coronary Artery Disease (blood, diagnostic imaging, mortality, therapy)
  • Coronary Thrombosis (blood, diagnostic imaging, mortality, prevention & control)
  • Factor Xa Inhibitors (administration & dosage, adverse effects)
  • Hemorrhage (chemically induced)
  • Humans
  • Percutaneous Coronary Intervention (adverse effects)
  • Platelet Aggregation (drug effects)
  • Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
  • Primary Prevention
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Secondary Prevention
  • Treatment Outcome

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