Center of Cardiology, Cardiology III - Angiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Hamostaseologie. 2022 Feb;42(1):73-79. doi: 10.1055/a-1724-4922. Epub 2022 Feb 23.
Antiplatelet and anticoagulant drugs work at different places in the coagulation system. Antiplatelet drugs are usually indicated in patients with atherosclerosis. Anticoagulant drugs are mostly used in patients with atrial fibrillation, venous thromboembolism, or technical heart valves. In some clinical situations, combination of antiplatelet and anticoagulant therapy can be indicated. The most recent situations are a more intensive antithrombotic therapy for risk reduction in patients with atherosclerosis and temporary addition of antiplatelet drugs in patients with indication for long-term anticoagulation. Temporary combination of antiplatelet and anticoagulant drugs is usually necessary after coronary intervention in patients with atrial fibrillation. In patients with high-risk atherosclerosis, the combination of low-dose rivaroxaban and aspirin reduces major adverse cardiovascular events (myocardial infarction, stroke, cardiovascular death) and major adverse limb events. But every combination of antiplatelet and antithrombotic drugs can increase bleeding risk. Therefore, a careful assessment of thrombotic versus bleeding risk is necessary for each patient.
抗血小板和抗凝药物在凝血系统的不同部位起作用。抗血小板药物通常适用于动脉粥样硬化患者。抗凝药物主要用于心房颤动、静脉血栓栓塞或人工心脏瓣膜患者。在某些临床情况下，可能需要联合应用抗血小板和抗凝治疗。最新情况是，对于动脉粥样硬化患者，采用更强化的抗血栓治疗以降低风险，以及对于有长期抗凝适应证的患者临时加用抗血小板药物。在有房颤的患者进行冠状动脉介入治疗后，通常需要临时联合应用抗血小板和抗凝药物。在高危动脉粥样硬化患者中，低剂量利伐沙班和阿司匹林联合应用可降低主要不良心血管事件（心肌梗死、卒中和心血管死亡）和主要不良肢体事件。但每种抗血小板和抗血栓药物的联合应用都会增加出血风险。因此，对于每位患者，都需要仔细评估血栓形成与出血风险。
