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Antiplatelet therapy following conservatively managed spontaneous coronary artery dissection

Madeline K Mahowald1, Luis Ortega-Paz2, Claudio Laudani2,3

  • 1Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA. madeline.mahowald@jax.ufl.edu.

Journal of Thrombosis and Thrombolysis
|May 25, 2025
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) requires optimal medical therapy, but current antiplatelet strategies are unclear. This review analyzes data and offers recommendations for antiplatelet use in SCAD patients.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS).
  • Optimal medical therapy for SCAD remains undefined.
  • Current treatment often follows guidelines for plaque-rupture ACS, using dual antiplatelet therapy (DAPT).

Purpose of the Study:

  • To review existing data on antiplatelet therapy in SCAD.
  • To analyze the impact of antiplatelet therapy on major adverse cardiac events (MACE) post-SCAD.
  • To provide clinical recommendations for antiplatelet management after conservative SCAD treatment.

Main Methods:

  • Comprehensive literature review of antiplatelet therapy in SCAD.
  • Inclusion of a meta-analysis of observational studies.
  • Synthesis of evidence to formulate clinical practice recommendations.

Main Results:

  • Observational studies show conflicting results regarding DAPT efficacy in SCAD.
  • Evidence supporting standard DAPT in SCAD is limited and derived from different ACS etiologies.
  • Further research is needed to clarify optimal antiplatelet strategies.

Conclusions:

  • Current recommendations for antiplatelet therapy in SCAD are based on limited evidence.
  • Conflicting data necessitates a cautious approach to DAPT in SCAD.
  • Clinical practice guidelines should be updated based on specific SCAD data and ongoing research.

Keywords:
Acute coronary syndromeAntiplatelet therapySpontaneous coronary artery dissection

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