Combined antiplatelet and novel oral anticoagulant therapy after acute coronary syndrome: is three a crowd?

Abstract

This editorial refers to ‘New oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome: a systematic review and meta-analysis’, by J. Oldgren et al. , doi:10.1093/eurheartj/eht049 The past 20 years have seen substantial advances in the short- and long-term outcomes for patients after acute coronary syndromes (ACS). Improvements in therapy and adherence to guidelines have resulted in a reduction in hospital mortality from 10.4% in 1994 to 6.3% in 2006.1 Despite this, ∼17% of patients surviving an ACS event would experience recurrent events without secondary prophylaxis, and even with the newer antithrombotics there remains an ∼10% risk of recurrence over 12 months.2,3 The high rates of recurrence highlight the need for more effective secondary prevention strategies. Besides novel antiplatelet therapies.3−5 novel anticoagulants have also been developed. They have first been tested in atrial fibrillation and shown to be effective in stroke prevention.6 Given the positive results obtained with warfarin on top of aspirin after myocardial infarction published >10 years ago,7,8 they have also been tested on a large scale after ACS.9,10 A meta-analysis about the use of the new-generation oral anticoagulant agents on top of single or dual antiplatelet therapy after ACS has now been published.11 Properly randomized controlled trials are lumped together for the evaluation of efficacy against the usual endpoints (cardiovascular) death, (re)infarction, or stroke. Also, the safety with these new agents on top of the standard of dual antiplatelet therapy has been evaluated. …