Key result
Coagulation proteins contribute significantly to atherothrombosis, and combining antiplatelet therapy with low-dose anticoagulants like rivaroxaban offers a promising strategy for vascular protection.
Combining antiplatelet and anticoagulant therapy, such as aspirin and low-dose rivaroxaban, represents a promising strategy to reduce residual atherothrombotic risk in patients with stable CAD and PAD.
May support dual pathway inhibition for residual risk in stable CAD/PAD; leaves open need for prospective validation of coagulation-targeted strategies.
Clinical manifestations of atherosclerotic disease include coronary artery disease (CAD), peripheral artery disease (PAD), and stroke. Although the role of platelets is well established, evidence is now accumulating on the contribution of coagulation proteins to the processes of atherosclerosis and atherothrombosis. Coagulation proteins not only play a role in fibrin formation and platelet activation, but also mediate various biological and pathophysiologic processes through activation of protease-activated-receptors (PARs). Thus far, secondary prevention in patients with CAD/PAD has been the domain of antiplatelet therapy, however, residual atherothrombotic risks remain substantial. Therefore, combining antiplatelet and anticoagulant therapy has gained more attention. Recently, net clinical benefit of combining aspirin with low-dose rivaroxaban in patients with stable atherosclerotic disease has been demonstrated. In this review, based on the State of the Art lecture "Clotting factors and atherothrombosis" presented at the ISTH Congress 2017, we highlight the role of coagulation proteins in the pathophysiology of atherothrombosis, and specifically focus on therapeutic strategies to decrease atherothrombotic events by optimization of vascular protection.
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Olie et al. (2018) conducted a review in Atherothrombosis (CAD, PAD, stroke). Combined antiplatelet and anticoagulant therapy (e.g., aspirin with low-dose rivaroxaban) was evaluated. Coagulation proteins contribute significantly to atherothrombosis, and combining antiplatelet therapy with low-dose anticoagulants like rivaroxaban offers a promising strategy for vascular protection.
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