Abstract
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.
Highlights
Patients with ischemic stroke present a 4-fold increased risk for coronary artery disease (CAD) compared to patients without cerebrovascular diseases (CVD) [1]
The present review is aimed at critically evaluating the available evidence on antithrombotic therapies in patients in sinus rhythm with acute or chronic CAD and history of CVD, without considering the antithrombotic strategies tested in the acute phase of cerebrovascular accidents
Examples of the terms used in the search strategy included ‘stroke, ‘coronary artery disease’, ‘acute coronary syndromes’, ‘antiplatelet therapy’, ‘aspirin’, ‘clopidogrel’, ‘ticlopidine’, ‘ticagrelor’, ‘dual antiplatelet therapy’, ‘oral anticoagulation therapy’, ‘warfarin’, ‘rivaroxaban’, ‘revascularization’, ‘benefits’, ‘mortality reduction’, and relevant individual risk factors
Summary
Patients with ischemic stroke present a 4-fold increased risk for coronary artery disease (CAD) compared to patients without cerebrovascular diseases (CVD) [1]. Patients with both CAD and CVD present a 3 times higher risk for stroke and intracranial bleeding compared with patients without history of CVD [1,2,3,4,5]. For these reasons, literature agrees in identifying this group of patients as challenging to manage, especially when the right balance between safety and efficacy of antithrombotic treatment needs to be find
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