Key result
Prolonged potent antiplatelet therapy in patients with coronary artery disease and prior stroke is associated with an extremely high risk of major bleeding complications.
Why the study?
Patients with CAD and prior cerebrovascular events have high rates of both ischemic and bleeding complications, making antithrombotic therapy selection clinically challenging.
Does antithrombotic therapy improve ischemic outcomes without excessive bleeding in patients with coronary artery disease and prior stroke?
Does antithrombotic therapy improve ischemic outcomes without excessive bleeding in patients with coronary artery disease and prior stroke?
Prolonged potent antithrombotic therapy in patients with CAD and prior stroke carries a high risk of major bleeding, requiring careful balancing of ischemic and bleeding risks.
Demands individualized antithrombotic decisions in CAD with prior stroke; leaves open net clinical benefit of prolonged potent regimens.
Patients with coronary artery disease (CAD) and prior cerebrovascular events (CVE) are frequently faced in clinical practice and present a high rate of both ischemic and bleeding events. For these reasons, the antithrombotic management is particularly challenging in this subgroup of patients. Recent trials suggest that, although a potent antiplatelet strategy is safe in the acute phases of myocardial ischemia for these patients, the risk of major bleeding complications, including intracranial hemorrhage, is extremely high when the antithrombotic therapy is prolonged for a long period of time. Therefore, especially in patients with chronic CAD and history of CVE, the antithrombotic management should be carefully balanced between ischemic and bleeding risks. The present review is aimed at critically evaluating the available evidence to help make these crucial clinical decisions regarding the better antithrombotic therapy to use in this high-risk subgroup of patients.
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Bellettini et al. (2021) conducted a review in Coronary artery disease and prior cerebrovascular events. Antithrombotic therapy was evaluated. Prolonged potent antiplatelet therapy in patients with coronary artery disease and prior stroke is associated with an extremely high risk of major bleeding complications.
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