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Review
. 2020 Apr;75(4):269-275.
doi: 10.1097/FJC.0000000000000795.

Direct Oral Anticoagulants and Coronary Artery Disease: The Debacle of the Aspirin Era?

Álvaro García-Ropero  1   2 , Ariana P Vargas-Delgado  1 , Carlos G Santos-Gallego  1 , Juan J Badimon  1
Affiliations

Affiliations

  • 1 Atherothrombosis Research Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; and.
  • 2 Cardiology Department, Imperial College London, the Royal Brompton and Harefield Hospital, London, United Kingdom.
Review

Direct Oral Anticoagulants and Coronary Artery Disease: The Debacle of the Aspirin Era?

Álvaro García-Ropero et al. J Cardiovasc Pharmacol. 2020 Apr.
. 2020 Apr;75(4):269-275.
doi: 10.1097/FJC.0000000000000795.

Authors

Álvaro García-Ropero  1   2 , Ariana P Vargas-Delgado  1 , Carlos G Santos-Gallego  1 , Juan J Badimon  1

Affiliations

  • 1 Atherothrombosis Research Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; and.
  • 2 Cardiology Department, Imperial College London, the Royal Brompton and Harefield Hospital, London, United Kingdom.

Abstract

Long-standing aspirin is the cornerstone to prevent recurrence of thrombotic events in patients with ischemic heart disease. However, clopidogrel, a more potent antiplatelet agent, is preferred over aspirin in targeted populations, including those with a high risk of gastrointestinal bleeding. In addition, clopidogrel offers superior oral tolerance, and it may reduce the rates of intracranial hemorrhages compared with aspirin. However, an extensive inhibition of the coagulation cascade seems to be reasonable to minimize thrombotic events in such patients. After several failed exploratory investigations in the past with vitamin K antagonists, the newest direct oral anticoagulants may represent an alternative. To counterbalance bleeding complications, a low dose of these agents should be considered. Few publications have already showed promising results with the combination of clopidogrel and low-dose direct oral anticoagulants. Further investigations should be addressed to elucidate whether this is the downfall of the aspirin era for secondary prevention of atherosclerotic cardiovascular events.

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References

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