Extended dual antithrombotic therapy in patients with chronic coronary syndrome - which agent should be added to...

Area of Science:

• Cardiology
• Pharmacology

Background:

• The 2024 ESC Guidelines suggest dual antithrombotic treatment for chronic coronary syndromes (CCS) in patients with increased ischemic risk.
• Current guidelines lack specific recommendations for selecting the second antithrombotic agent beyond aspirin.
• This ambiguity may lead to suboptimal therapeutic decisions in clinical practice.

Purpose of the Study:

• To critically evaluate the evidence supporting the choice of a second antithrombotic agent for extended long-term prevention in CCS.
• To address the limitations and potential misinterpretations of Number Needed to Treat (NNT) and Number Needed to Harm (NNH) data presented in the guidelines.

Main Methods:

• Review of existing clinical trial data and meta-analyses on dual antithrombotic therapies in CCS.
• Analysis of NNT and NNH figures provided in the 2024 ESC Guidelines.
• Critical appraisal of the methodologies and statistical presentations within the guidelines.

Main Results:

• The guidelines' presented NNT and NNH data for antithrombotic medications are potentially misleading.
• A lack of clear comparative efficacy and safety data hinders optimal agent selection.
• The evidence review highlights significant limitations in the current guideline recommendations.

Conclusions:

• Careful verification and commentary on the data presented in the 2024 ESC Guidelines are crucial.
• Further research is needed to provide clearer evidence-based recommendations for second antithrombotic agent selection in CCS.
• Clinicians must exercise caution when interpreting guideline data to avoid unjustified therapeutic decisions.