[Recent developments in secondary cardiovascular prevention: the pros and cons of dual pathway inhibition]

Area of Science:

• Cardiology
• Pharmacology
• Geriatrics

Background:

• Growing elderly population with cardiovascular diseases and multimorbidity.
• Ongoing research for optimal antithrombotic therapies to prevent cardiovascular events.
• Traditional therapies include aspirin monotherapy.

Purpose of the Study:

• To evaluate the efficacy and safety of dual pathway inhibition (DPI) compared to aspirin monotherapy.
• To identify patient subgroups who benefit most from DPI.

Main Methods:

• Investigated large clinical trials on DPI, a combination of a platelet aggregation inhibitor (aspirin) and a low-dose anticoagulant (rivaroxaban).
• Assessed inhibition of primary and secondary hemostasis by DPI.
• Analyzed risk reduction of ischemic events versus bleeding risk.

Main Results:

• DPI significantly reduces ischemic cardiovascular events compared to aspirin monotherapy.
• DPI increases the risk of bleeding.
• Patients with high ischemic risk and low bleeding risk show the greatest net clinical benefit.

Conclusions:

• Dual pathway inhibition (aspirin plus rivaroxaban) is a promising antithrombotic strategy.
• Careful patient selection is crucial to maximize benefits and minimize risks.
• DPI is particularly beneficial for patients with polyvascular disease, heart failure, renal insufficiency, and diabetes.