Why the study?
Despite optimal antiplatelet therapy after ACS, recurrent thrombotic complications remain high, prompting increasing off-licence use of NOACs in ischemic coronary disease.
Do NOACs added to antiplatelet therapy reduce ischemic events in patients with acute coronary syndrome?
Do NOACs added to antiplatelet therapy reduce ischemic events in patients with acute coronary syndrome?
Answers are grounded in this paper and cite their sources.
While NOACs added to antiplatelet therapy in ACS reduce ischemic events, their routine use is limited by a significant increase in major bleeding risk.
Acute coronary syndrome (ACS) is a leading cause of mortality worldwide. Despite optimal antiplatelet therapy recommendation after ischemic events, recurrent thrombotic complications rate remains high. The recurrent events maybe in part due to increased thrombin levels during ACS which may underscore the need for an additional anticoagulation therapy. Given the advantages of non-vitamin K antagonist oral anticoagulants (NOACs) over warfarin, they have the potential to prevent thrombus formation, in the presence or absence of atrial fibrillation, but at the cost of increased risk of bleeding. NOACs have also shown a promising efficacy in managing left ventricular thrombus and a potential benefit in avoiding stent thrombosis after percutaneous coronary revascularization. Taken as a whole, NOACs are increasingly used for off-licence indications, and continue to evolve as essential therapy in preventing and treating thrombotic events. Herein, this review discusses NOACs off-label indications in the setting of ischemic coronary disease.
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Kaddoura et al. (2023) studied this question.
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