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Antithrombotic Strategy in Secondary Prevention for High-Risk Patients with Previous Acute Coronary Syndrome: Overlap

Michele Millesimo1, Edoardo Elia2, Giorgio Marengo2

  • 1Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy. michele.millesimo@gmail.com.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|November 1, 2022
PubMed

Insights

One-third of acute coronary syndrome (ACS) patients are eligible for prolonged dual antiplatelet therapy (DAPT) or dual pathway inhibition, offering new strategies for preventing recurrent cardiovascular events.

Area of Science:

  • Cardiology
  • Clinical Research
  • Pharmacology

Background:

  • Patients with previous acute coronary syndrome (ACS) face a high risk of recurrent cardiovascular events.
  • Prolonged dual antiplatelet therapy (DAPT) and oral anticoagulation therapy (OAT) reduce ischemic events but increase bleeding.
  • Real-world eligibility for these advanced therapies in ACS patients requires determination.

Purpose of the Study:

  • To assess the proportion of ACS patients eligible for the PEGASUS strategy (prolonged DAPT) and the COMPASS strategy (dual pathway inhibition).
  • To determine the overlap in eligibility between the PEGASUS and COMPASS strategies.
  • To identify the number of patients eligible for only one strategy or neither.

Main Methods:

  • Analysis of data from five registries and one randomized controlled trial involving ACS patients.
  • Evaluation of eligibility for the PEGASUS strategy (ticagrelor 60 mg + low-dose aspirin).
  • Evaluation of eligibility for the COMPASS strategy (rivaroxaban 2.5 mg + low-dose aspirin).

Main Results:

  • Out of 10,048 patients, 53.4% were eligible for PEGASUS and 38.2% for COMPASS.
  • A significant overlap of 34.4% was observed between PEGASUS and COMPASS eligibility.
  • 19.2% were eligible only for PEGASUS, 4.0% only for COMPASS, and 42.6% were eligible for neither.

Conclusions:

  • Approximately one in three ACS patients in this large cohort qualified for either prolonged DAPT or dual pathway inhibition.
  • These findings highlight the potential real-world application of advanced antithrombotic strategies in ACS management.
  • Further research may explore optimal treatment selection for patients eligible for these distinct therapeutic approaches.
Abstract

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