University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
Department of Clinical and Experimental Medicine, University of Florence, Careggi Hospital, Florence, Italy.
Biomed Pharmacother. 2021 Aug;140:111783. doi: 10.1016/j.biopha.2021.111783. Epub 2021 Jun 5.
Despite recent achievements in secondary cardiovascular prevention, the risk of further events in patients with chronic coronary syndromes (CCS) remains elevated. Highest risk is seen in patients with recurrent events, comorbidities or multisite atherosclerosis. Optimising antithrombotic strategies in this setting may significantly improve outcomes. The higher the baseline risk, the higher the absolute event reduction with approaches using combined antithrombotic treatments. Tailoring such strategies to the individual patient risk appears crucial to achieve net benefit (i.e., substantial ischaemic event prevention at a limited cost in terms of bleeding). This paper focuses on antithrombotic and non-pharmacological approaches to secondary cardiovascular disease prevention in CCS. In particular, we critically review current evidence on the use of dual antithrombotic therapy, including the newest approach of aspirin plus low-dose anticoagulation and its net clinical outcome according to baseline risk.
尽管在二级心血管预防方面取得了新的进展，但慢性冠状动脉综合征（CCS）患者的进一步事件风险仍然较高。复发事件、合并症或多部位动脉粥样硬化的患者风险最高。优化这种情况下的抗血栓策略可能会显著改善结果。基线风险越高，采用联合抗血栓治疗方法的绝对事件减少就越高。为实现净效益（即在出血方面的有限代价下实现实质性的缺血性事件预防），将这些策略定制为针对个体患者风险显得至关重要。本文重点关注 CCS 二级心血管疾病预防中的抗血栓和非药物方法。特别是，我们批判性地审查了双重抗血栓治疗的最新证据，包括阿司匹林加低剂量抗凝的最新方法及其根据基线风险的净临床结果。
