Modern Approaches to Optimal Antithrombotic Therapy for Stable Ischemic Heart Disease

Abstract

The article highlights the practical aspects of the use of antithrombotic therapy in patients with stable (chronic) coronary artery disease (САD). The САD verification using modern functional and anatomical diagnostic methods are considered. Patients with stable САD represent a heterogeneous group, having various clinical scenarios. Information is provided on the main risk factors for ischemic and hemorrhagic complications that determine the choice of optimal antithrombotic therapy regimens. Modern views on the monotherapy and clopidogrel in САD are presented. The data of the largest international studies CHARISMA and PEGASUS-TIMI 54 on the use of double antiplatelet therapy in patients with stable IHD reflected in modern guidelines are highlighted. Features of new antiplatelet agents (prasugrel and ticagrelol) are described. Based on the results of the COMPASS study, indications for the administration of small doses of rivaroxaban in combination with aspirin for the secondary prevention of cardiovascular complications in patients with stable manifestations of atherosclerosis with a low risk of bleeding are considered. The use of antithrombotic therapy is associated with an increased risk of bleeding and particularly with gastrointestinal bleeding. The information on the use of drugs for the prevention of gastrointestinal bleeding is provided.Antithrombotic therapy can reduce the risk of complications associated with atherothrombosis, however, to improve prognosis a multipurpose intervention is required, including correction of risk factors and the use of drugs from different groups with proven effectiveness. Optimal medical therapy, including antithrombotic drugs, is vital for patients with САD and can successfully prevent adverse outcomes.