Minerva Cardiology and Angiology 2021 Nov 11

DOI: 10.23736/S2724-5683.21.05867-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Dual pathway inhibition in atherothrombosis prevention: yes, now we can!

Francesco SUMMARIA ¹ ✉, Giuseppe BIONDI-ZOCCAI ^{2, 3}, Enrico ROMAGNOLI ⁴, Mamas A. MAMAS ⁵, Francesco FRANCHI ⁶, Paolo SEVERINO ⁷, Carlo LAVALLE ⁷, Francesco VERSACI ⁸, Achille GASPARDONE ¹, Deepak L. BHATT ⁹

¹ Division of Cardiology, San Eugenio Hospital, Rome, Italy; ² Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; ³ Mediterranea Cardiocentro, Napoli, Italy; ⁴ Division of Cardiology, Catholic University of the Sacred Heart, Rome, Italy; ⁵ Keele Cardiovascular Research group, Keele University, Keele, Newcastle, UK; ⁶ Division of Cardiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA; ⁷ Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; ⁸ Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy; ⁹ Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School Boston, MA, USA

Despite ongoing developments, prevention and treatment of atherothrombotic cardiovascular disease remains a common challenge. Antithrombotic options for cardiocerebrovascular disease prevention involves a choice between dual antiplatelet therapy (DAPT) and dual pathway inhibition (DPI), which includes an antiplatelet agent and a reduced dose anticoagulant agent. In selected patients at high risk of event and low risk of bleeding, especially those undergoing recent and complex coronary revascularization using drug-eluting stents (DES) (“revascularization-driven effect”), DAPT is superior to single antiplatelet therapy with aspirin. DPI involves a wider potential range of treatment and is superior to single antiplatelet therapy with aspirin, particularly in patients with atherothrombotic involvement in different vascular beds both previously revascularized and not (“no revascularization-driven effect”). After nearly thirty years of randomized trials and observational registries, we have sufficient data to customize antithrombotic therapy in patients at high cardiovascular risk. Therefore, “atherothrombosis stakeholders” must identify the right patient for the right therapy to ensure high levels of efficacy and safety with the best of current therapeutic opportunities.

KEY WORDS: Anticoagulant therapy; Antiplatelet therapy; Atherosclerosis; Atherothrombosis; Dual antiplatelet therapy; Dual pathway inhibition