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Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review
Despite evidence-based therapies, patients presenting with atherosclerosis involving more than one vascular bed, such as those with peripheral artery disease (PAD) and concomitant coronary artery disease (CAD), constitute a particularly vulnerable group characterized by enhanced residual long-term r...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455400/ https://www.ncbi.nlm.nih.gov/pubmed/37629326 http://dx.doi.org/10.3390/jcm12165284 |
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author | Magnani, Giulia Denegri, Andrea Gurgoglione, Filippo Luca Barocelli, Federico Indrigo, Elia Catellani, Davide Signoretta, Gianluca Bettella, Alberto Tuttolomondo, Domenico Solinas, Emilia Nicolini, Francesco Niccoli, Giampaolo Ardissino, Diego |
author_facet | Magnani, Giulia Denegri, Andrea Gurgoglione, Filippo Luca Barocelli, Federico Indrigo, Elia Catellani, Davide Signoretta, Gianluca Bettella, Alberto Tuttolomondo, Domenico Solinas, Emilia Nicolini, Francesco Niccoli, Giampaolo Ardissino, Diego |
author_sort | Magnani, Giulia |
collection | PubMed |
description | Despite evidence-based therapies, patients presenting with atherosclerosis involving more than one vascular bed, such as those with peripheral artery disease (PAD) and concomitant coronary artery disease (CAD), constitute a particularly vulnerable group characterized by enhanced residual long-term risk for major adverse cardiac events (MACE), as well as major adverse limb events (MALE). The latter are progressively emerging as a difficult outcome to target, being correlated with increased mortality. Antithrombotic therapy is the mainstay of secondary prevention in both patients with PAD or CAD; however, the optimal intensity of such therapy is still a topic of debate, particularly in the post-acute and long-term setting. Recent well-powered randomized clinical trials (RCTs) have provided data in favor of a more intense antithrombotic therapy, such as prolonged dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor or a therapy with aspirin combined with an anticoagulant drug. Both approaches increase bleeding and selection of patients is a key issue. The aim of this review is, therefore, to discuss and summarize the most up-to-date available evidence for different strategies of anti-thrombotic therapies in patients with chronic PAD and CAD, particularly focusing on studies enrolling patients with both types of atherosclerotic disease and comparing a higher- versus a lower-intensity antithrombotic strategy. The final objective is to identify the optimal tailored approach in this setting, to achieve the greatest cardiovascular benefit and improve precision medicine. |
format | Online Article Text |
id | pubmed-10455400 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-104554002023-08-26 Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review Magnani, Giulia Denegri, Andrea Gurgoglione, Filippo Luca Barocelli, Federico Indrigo, Elia Catellani, Davide Signoretta, Gianluca Bettella, Alberto Tuttolomondo, Domenico Solinas, Emilia Nicolini, Francesco Niccoli, Giampaolo Ardissino, Diego J Clin Med Review Despite evidence-based therapies, patients presenting with atherosclerosis involving more than one vascular bed, such as those with peripheral artery disease (PAD) and concomitant coronary artery disease (CAD), constitute a particularly vulnerable group characterized by enhanced residual long-term risk for major adverse cardiac events (MACE), as well as major adverse limb events (MALE). The latter are progressively emerging as a difficult outcome to target, being correlated with increased mortality. Antithrombotic therapy is the mainstay of secondary prevention in both patients with PAD or CAD; however, the optimal intensity of such therapy is still a topic of debate, particularly in the post-acute and long-term setting. Recent well-powered randomized clinical trials (RCTs) have provided data in favor of a more intense antithrombotic therapy, such as prolonged dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor or a therapy with aspirin combined with an anticoagulant drug. Both approaches increase bleeding and selection of patients is a key issue. The aim of this review is, therefore, to discuss and summarize the most up-to-date available evidence for different strategies of anti-thrombotic therapies in patients with chronic PAD and CAD, particularly focusing on studies enrolling patients with both types of atherosclerotic disease and comparing a higher- versus a lower-intensity antithrombotic strategy. The final objective is to identify the optimal tailored approach in this setting, to achieve the greatest cardiovascular benefit and improve precision medicine. MDPI 2023-08-14 /pmc/articles/PMC10455400/ /pubmed/37629326 http://dx.doi.org/10.3390/jcm12165284 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Magnani, Giulia Denegri, Andrea Gurgoglione, Filippo Luca Barocelli, Federico Indrigo, Elia Catellani, Davide Signoretta, Gianluca Bettella, Alberto Tuttolomondo, Domenico Solinas, Emilia Nicolini, Francesco Niccoli, Giampaolo Ardissino, Diego Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review |
title | Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review |
title_full | Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review |
title_fullStr | Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review |
title_full_unstemmed | Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review |
title_short | Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review |
title_sort | dual antiplatelet therapy or antiplatelet plus anticoagulant therapy in patients with peripheral and chronic coronary artery disease: an updated review |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455400/ https://www.ncbi.nlm.nih.gov/pubmed/37629326 http://dx.doi.org/10.3390/jcm12165284 |
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