Chronic Coronary Syndrome: Overcoming Clinical Practice Guidelines. The role of the COMPASS Strategy

Area of Science:

• Cardiology
• Pharmacology
• Vascular Medicine

Background:

• Current European guidelines recommend lifelong low-dose aspirin for chronic coronary syndromes.
• Dual antithrombotic therapy is considered for patients at moderate-to-high risk of ischemic events without high bleeding risk.
• Treatment options include aspirin combined with clopidogrel, prasugrel, ticagrelor, or rivaroxaban.

Purpose of the Study:

• To evaluate the efficacy and safety of different dual antithrombotic therapy options in chronic coronary syndromes.
• To analyze the impact of various drug combinations on cardiovascular events and mortality.
• To explore the role of platelet and Factor X activation in atherothrombosis management.

Main Methods:

• Review of current European guidelines on chronic coronary syndromes.
• Analysis of clinical trial data supporting dual antithrombotic therapy recommendations.
• Secondary analysis focusing on cardiovascular and overall mortality reduction.

Main Results:

• All evaluated dual antithrombotic therapies significantly reduced major cardiovascular events in stable atherosclerotic disease.
• The addition of rivaroxaban was associated with a reduction in cardiovascular and overall mortality in secondary analysis.
• Guidelines do not differentiate between treatment options despite divergent clinical trial results.

Conclusions:

• Dual antithrombotic therapy is a viable strategy for select chronic coronary syndrome patients.
• Rivaroxaban's unique mortality benefit suggests targeting both platelets and Factor X is crucial for atherothrombosis.
• Further research may be needed to differentiate the benefits of specific dual antithrombotic regimens.