Prevention of stroke in patients with chronic coronary syndromes or peripheral arterial disease

Area of Science:

• Cardiovascular Medicine
• Neurology

Background:

• Stroke is a major cause of disability, often linked to atherothrombosis, thromboembolism, or hemorrhage.
• Patients with chronic coronary syndromes (CCS) or peripheral artery disease (PAD) share risk factors and pathophysiological mechanisms, increasing their susceptibility to stroke.

Purpose of the Study:

• To outline strategies for reducing stroke risk in patients with CCS or symptomatic PAD.
• To discuss the benefits and risks of various antithrombotic therapies in this patient population.

Main Methods:

• Review of pharmacological and non-pharmacological interventions for stroke prevention.
• Analysis of antithrombotic therapy options including single antiplatelet therapy, dual antiplatelet therapy, and dual antithrombotic therapy.
• Consideration of risk factors such as atrial fibrillation, blood pressure, and lipid levels.

Main Results:

• Antithrombotic therapy reduces ischemic stroke risk but increases hemorrhagic stroke risk; net benefits support its use in CCS/PAD.
• Dual antiplatelet therapy or dual antithrombotic therapy with aspirin and low-dose rivaroxaban are options for specific CCS/PAD patients.
• Full-dose anticoagulation is essential for CCS/PAD patients with atrial fibrillation, generally without added antiplatelet therapy.

Conclusions:

• A comprehensive, multifaceted strategy is vital for effective stroke prevention in patients with CCS and PAD.
• Optimizing medical management, including antithrombotic therapy and control of modifiable risk factors, is key to mitigating stroke risk.