[Antiplatelet therapy and anticoagulation in patients with coronary heart disease]

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Coronary heart disease (CHD) presents acute and chronic phases, contributing to significant mortality.
• Effective management of CHD involves differentiated antithrombotic strategies tailored to disease phase and patient risk.
• Current European Society of Cardiology (ESC) guidelines distinguish between acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).

Purpose of the Study:

• To provide an overview of antithrombotic drug options for coronary heart disease.
• To outline therapeutic algorithms for ACS and CCS based on the latest ESC guidelines.
• To discuss the integration of antiplatelet agents and anticoagulants in CHD management.

Main Methods:

• Review of current ESC guidelines for antithrombotic therapy in CHD.
• Analysis of therapeutic strategies for acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).
• Discussion of drug combinations, dosages, and treatment durations based on clinical scenarios and comorbidities.

Main Results:

• Initial ACS therapy typically involves acetylsalicylic acid and a P2Y12-inhibitor for 12 months.
• Post-ACS treatment options include aspirin monotherapy, prolonged dual antiplatelet therapy, or dual antithrombotic therapy with aspirin and low-dose rivaroxaban.
• For patients with atrial fibrillation, anticoagulation is essential, transitioning to anticoagulant monotherapy in the chronic phase (CCS).

Conclusions:

• Antithrombotic therapy for CHD must be individualized, considering thrombotic risk, bleeding risk, and comorbidities like atrial fibrillation.
• Adherence to updated ESC guidelines ensures optimal antithrombotic management across different CHD phases.
• The strategic use of antiplatelet agents and anticoagulants, including Xa-inhibitors, is crucial for improving outcomes in CHD patients.