Evolving paradigms in antithrombotic therapy for anticoagulated patients undergoing coronary stenting

Area of Science:

• Cardiology
• Pharmacology
• Thrombosis Research

Background:

• Coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) often require oral anticoagulant therapy (OAC), frequently due to atrial fibrillation (AF).
• This dual indication increases the risk of thrombotic complications, necessitating comprehensive antithrombotic strategies targeting both platelet and coagulation pathways.
• Traditional triple therapy carries a significant bleeding risk, prompting research into safer alternatives.

Purpose of the Study:

• To review and critically assess recent randomized clinical trials on antithrombotic management in patients needing OAC and PCI.
• To evaluate pharmacological strategies balancing efficacy and safety in this high-risk population.
• To summarize evolving treatment paradigms for CAD patients with AF undergoing PCI.

Main Methods:

• Systematic review of recent randomized clinical trials.
• Critical evaluation of pharmacological interventions in antithrombotic therapy.
• Analysis of treatment strategies for patients requiring both OAC and antiplatelet therapy post-PCI.

Main Results:

• Recent trials have investigated novel antithrombotic combinations to mitigate risks associated with triple therapy.
• Evolving treatment strategies aim to optimize the balance between preventing ischemic events and reducing bleeding complications.
• Evidence suggests shifts in management paradigms for patients with concurrent AF and CAD requiring PCI.

Conclusions:

• The management of antithrombotic therapy in patients with CAD, AF, and PCI indication is complex and evolving.
• Balancing the prevention of thrombotic events with the risk of bleeding remains a key challenge.
• Ongoing research focuses on safer and more effective pharmacological combinations for this patient group.