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Antithrombotic therapy for secondary prevention of atherothrombotic events in cerebrovascular disease

Davide Capodanno1, Mark Alberts2, Dominick J Angiolillo3

  • 1Ferrarotto Hospital, University of Catania, Via Salvatore Citelli 6, 95124 Catania CT, Italy.

Nature Reviews. Cardiology
|August 5, 2016
PubMed

Insights

Atherothrombosis, a key factor in cardiovascular and cerebrovascular diseases, requires careful antiplatelet therapy. This review examines evidence for preventing recurrent events in patients with both conditions, balancing risks of stroke and bleeding.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Atherothrombosis underlies coronary artery disease (CAD) and cerebrovascular disease (CVD).
  • Antiplatelet therapy is crucial for managing atherothrombosis, with significant advances in CAD treatment.
  • Concomitant CAD and CVD present complex challenges due to elevated risks of ischemia and hemorrhage.

Purpose of the Study:

  • To review current evidence on antithrombotic therapies for secondary prevention in patients with concurrent CAD and CVD.
  • To address the uncertainty surrounding the risk-benefit profile of antiplatelet combinations in this high-risk population.

Main Methods:

  • Systematic review of existing literature on antithrombotic treatments.
  • Analysis of evidence focusing on patients with a history of noncardioembolic stroke or transient ischemic attack (TIA).

Main Results:

  • Antiplatelet agents are essential for preventing stroke or TIA in CVD patients with large artery atherosclerosis.
  • Balancing the benefits of stroke prevention against the risk of intracranial hemorrhage with antithrombotics is critical.
  • The optimal risk-benefit profile for combined antiplatelet therapy in patients with both CAD and CVD remains uncertain.

Conclusions:

  • Antithrombotic therapies are vital for secondary prevention in patients with concomitant CAD and CVD.
  • Further research is needed to clarify the optimal use of antiplatelet agents to mitigate both ischemic and bleeding risks.
  • This review synthesizes current knowledge to guide clinical decision-making in complex atherothrombotic cases.

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