Anticoagulants for secondary prevention after acute myocardial infarction: lessons from the past decade

Area of Science:

• Cardiology
• Thrombosis Research
• Pharmacology

Background:

• Acute coronary syndrome (ACS) and acute myocardial infarction (MI) necessitate long-term management due to persistent atherothrombotic risk.
• Advances in antiplatelet therapies have improved prognoses, yet residual risks of recurrent events, stroke, and mortality persist.
• Challenges in managing residual risk include patient variability, diverse clinical practices, incomplete understanding of post-ACS thrombosis, and therapeutic limitations.

Purpose of the Study:

• To review progress in reducing secondary thromboembolic events following acute MI over the past decade.
• To discuss the current role and future perspectives of oral anticoagulants in post-MI care pathways.

Main Methods:

• Literature review of advancements in acute and chronic management of MI patients.
• Analysis of evolving antiplatelet and anticoagulant treatment strategies.
• Discussion of clinical trial data and expert recommendations on residual risk management.

Main Results:

• Significant improvements in MI prognosis achieved through aggressive antiplatelet regimens.
• Emergence of direct oral anticoagulants, such as rivaroxaban, as a potential addition to standard therapy.
• Ongoing evolution of clinical strategies to address persistent atherothrombotic risk.

Conclusions:

• Despite therapeutic advances, residual risk after ACS/MI remains a critical clinical challenge.
• Oral anticoagulants represent a novel therapeutic avenue for selected high-risk patients.
• Future care pathways will likely integrate these agents to further mitigate long-term cardiovascular events.