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Current Strategies for Optimizing Antithrombotic Therapy in Patients with Chronic Coronary Syndrome: A Dynamic
Abi Selvarajah1, Enrico Fabris2, Maarten A H van Leeuwen1
1Department of Cardiology, Isala Hospital, Zwolle, Overijssel, the Netherlands.
Summary
The 2024 European Society of Cardiology guidelines update antithrombotic therapy for chronic coronary syndrome (CCS). Management now emphasizes individualized strategies based on patient ischemic and bleeding risk, moving beyond a one-size-fits-all approach.
Area of Science:
- Cardiology
- Vascular Medicine
- Pharmacology
Background:
- Chronic coronary syndrome (CCS) involves persistent atherosclerosis and atherothrombotic risk.
- Antithrombotic therapy is crucial for secondary prevention in CCS.
- Treatment strategies have evolved with new clinical trial data.
Purpose of the Study:
- Summarize key updates in the 2024 European Society of Cardiology (ESC) guidelines for CCS.
- Review the clinical evidence supporting these guideline changes.
- Highlight the shift towards individualized antithrombotic treatment strategies.
Main Methods:
- Narrative review of the 2024 ESC CCS guidelines.
- Analysis of evidence from randomized clinical trials and meta-analyses.
- Focus on antiplatelet and anticoagulant strategies.
Main Results:
- Management is now individualized based on ischemic and bleeding risk.
- Single antiplatelet therapy is foundational; clopidogrel is an alternative to aspirin.
- Dual antiplatelet therapy (DAPT) duration post-PCI is risk-adapted, with shorter courses for high bleeding risk patients.
- Intensified strategies may benefit high ischemic risk, low bleeding risk patients.
Conclusions:
- Updated recommendations stress patient-centered risk stratification and reassessment.
- Tools like ARC-HBR and PRECISE-DAPT aid in tailoring antithrombotic therapy.
- Optimizing net clinical benefit requires integrating clinical judgment with risk assessment tools.
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