Combination Antiplatelet and Oral Anticoagulant Therapy in Patients With Coronary and Peripheral Artery Disease

Area of Science:

• Cardiovascular Medicine
• Hematology
• Pharmacology

Background:

• Antiplatelet therapy, including dual antiplatelet therapy (DAPT) with aspirin and clopidogrel or more potent P2Y12 inhibitors, is the standard for managing coronary and peripheral artery disease.
• Despite DAPT, approximately 10% of patients experience recurrent thrombotic events within a year after an acute coronary syndrome (ACS).

Purpose of the Study:

• To review the evolving understanding of platelet and coagulation factor roles in atherothrombosis.
• To discuss the rationale and clinical evidence for combining antiplatelet agents with oral anticoagulants in patients with coronary and peripheral artery disease.

Main Methods:

• Review of current literature on atherothrombosis, antiplatelet therapy, and anticoagulant therapy.
• Analysis of clinical trial data investigating combined antiplatelet and anticoagulant strategies.
• Exploration of basic and translational research on coagulation factor inhibition.

Main Results:

• DAPT has improved outcomes compared to monotherapy but has limitations in preventing recurrent events.
• Investigational approaches include low-dose oral anticoagulation alongside or instead of aspirin in P2Y12 inhibitor-treated patients.
• Emerging research suggests noncanonical effects of coagulation factor inhibition may enhance clinical benefits.

Conclusions:

• Recurrent thrombotic events remain a challenge despite potent antiplatelet therapies.
• Combining antiplatelet and oral anticoagulant therapy is an active area of research for improving outcomes in atherothrombotic disease.
• Further investigation is needed to optimize combination strategies for safety and efficacy.