Current evidence and future directions in antiplatelet therapy for spontaneous coronary artery dissection: balancing...

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndromes (ACS), especially in young women.
• Conservative management is preferred for stable SCAD patients, but antiplatelet therapy's role is unclear.
• Current practices extrapolate from ACS guidelines, lacking specific evidence for SCAD.

Purpose of the Study:

• To review the literature on antiplatelet therapy after conservative SCAD management.
• To examine mechanistic rationale, guidelines, registry data, and clinical approaches.
• To highlight evidence limitations and the need for randomized trials.

Main Methods:

• Literature review of antiplatelet therapy in SCAD.
• Analysis of mechanistic rationale and guideline recommendations.
• Evaluation of observational registry data.

Main Results:

• Conflicting results exist regarding antiplatelet therapy benefits and risks in SCAD.
• Some studies suggest reduced recurrent ischemic events, while others note increased bleeding or hematoma propagation.
• Evidence for optimal antiplatelet strategy in SCAD is limited.

Conclusions:

• Antiplatelet therapy in SCAD requires individualized approaches.
• Current evidence is insufficient to guide definitive treatment.
• Randomized controlled trials are essential to establish optimal antiplatelet strategies for SCAD.