Dilemmas in the Cardio-Vascular Treatment Approach. Anticoagulant, Antiplatelet Drug or a Combination?

Abstract

Introduction: Antithrombotic agents are drugs which prevent or reduce blood clotting by manipulating the various pathways of blood coagulation. They are prescribed to patients who are at high risk of getting clots, because they prevent thrombotic cerebrovascular and cardiovascular disease. Both of groups can be used separately or in a combination. Questions arise when the patient has numerous cardiovascular diseases. For illustration, authors present a clinical report about the difficulties in the treatment of a patient with atrial fibrillation, history of two myocardial infarctions and coronary-artery bypass graft (CABG).The aim is to show the indications for using anticoagulants and/or antiplatelet drugs, when and how to combine them, the risk and benefits of using antithrombotic drugs. Materials and Methods: A 65-year-old male patient, complaining of acute palpitations, breathlessness, accompanied by high values of blood pressure (180/100 mmHg). He has a long history of cardiovascular diseases. They started with an arterial hypertension in 1995, followed by two myocardial infarctions in 2000 and 2002. In 2008, three coronary-artery bypass grafts were made. Thereafter, the patient did not have any stenocardial pain. One year ago he had an episode of atrial fibrillation. Before arriving in the hospital, the patient was only on Aspirin therapy without any anticoagulant agents. At discharge from the clinic his therapy was changed. Results and Conclusion: Anticoagulants represent the mainstay of therapy for most patients with atrial fibrillation. Patients on oral anticoagulation often require concomitant antiplatelet therapy, mostly because of coronary artery disease. However, the combination of oral anticoagulation and antiplatelet therapy increases the bleeding risk. The question of whether or not combination antithrombotic therapy is beneficial in terms of a reduction in fatal and non-fatal vascular events in atrial fibrillation is an important question which essentially remains unanswered.