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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Combining Colchicine and Antiplatelet Therapy to Tackle Atherothrombosis: A Paradigm in Transition?

by
Salvatore Giordano
1,†,
Marina Camera
2,3,†,
Marta Brambilla
3,
Gianmarco Sarto
4,
Luigi Spadafora
4,
Marco Bernardi
4,
Antonio Iaconelli
5,
Domenico D’Amario
6,
Giuseppe Biondi-Zoccai
4,7,
Alessandra Ida Celia
8,
Elena Tremoli
7,
Giacomo Frati
4,9,
Dominick J. Angiolillo
10,
Sebastiano Sciarretta
4,9 and
Mattia Galli
4,7,*
1
Department of Medical and Surgical Sciences, Division of Cardiology, ’Magna Graecia’ University, 88100 Catanzaro, Italy
2
Department of Pharmaceutical Sciences, Università degli Studi di Milano, 20133 Milan, Italy
3
Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
4
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
5
Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
6
Department of Translational Medicine, Division of Cardiology, Università del Piemonte Orientale, AOU Maggiore della Carità, 28100 Novara, Italy
7
Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy
8
Rheumatology, Department of Clinical Internal, Anestesiological e Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
9
IRCCS NeuroMed, 86077 Pozzilli, Italy
10
Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA
*
Author to whom correspondence should be addressed.
†
These authors equally contributed.
Int. J. Mol. Sci. 2025, 26(3), 1136; https://doi.org/10.3390/ijms26031136
Submission received: 13 December 2024 / Revised: 13 January 2025 / Accepted: 21 January 2025 / Published: 28 January 2025
(This article belongs to the Special Issue Molecular Insights into Thrombosis)
Review Reports Versions Notes

Abstract

Atherothrombosis, the primary driver of acute cardiovascular (CV) events, is characterized by the activation of three key pathophysiological pathways: platelets, coagulation, and inflammation. Dual antiplatelet therapy (DAPT) is the current standard of care for patients with acute coronary syndrome, providing significant reductions in cardiovascular (CV) events, albeit with an associated increased risk of bleeding. However, the high residual risk of recurrent events among these patients highlights the need for alternative strategies to treat and prevent atherothrombosis. To this extent, several approaches aimed at targeting atherothrombosis have been proposed. Among these, a strategy of dual-pathway inhibition simultaneously targeting platelets, using single or DAPT, and coagulation, using a low-dose anticoagulant such as rivaroxaban 2.5 mg twice daily, has shown to reduce CV events but at the expense of increased bleeding. Targeting inflammatory pathways has the potential to be a highly effective strategy to tackle atherothrombosis without increasing bleeding risk. Several anti-inflammatory agents have been tested in patients with coronary artery disease, but to date only colchicine is approved for secondary prevention on top of standard care, including antiplatelet therapy. However, many aspects of colchicine’s mechanism of action, including its antiplatelet effects and how it synergizes with antiplatelet therapy, remain unclear. In this review, we summarize the available clinical and pre-clinical evidence on the antiplatelet effects of colchicine and its synergistic interactions with antiplatelet therapy, highlighting their potential role in addressing atherothrombosis.
Keywords: atherothrombosis; inflammation; colchicine; antiplatelet; thrombo-inflammation atherothrombosis; inflammation; colchicine; antiplatelet; thrombo-inflammation

Share and Cite

MDPI and ACS Style

Giordano, S.; Camera, M.; Brambilla, M.; Sarto, G.; Spadafora, L.; Bernardi, M.; Iaconelli, A.; D’Amario, D.; Biondi-Zoccai, G.; Celia, A.I.; et al. Combining Colchicine and Antiplatelet Therapy to Tackle Atherothrombosis: A Paradigm in Transition? Int. J. Mol. Sci. 2025, 26, 1136. https://doi.org/10.3390/ijms26031136

AMA Style

Giordano S, Camera M, Brambilla M, Sarto G, Spadafora L, Bernardi M, Iaconelli A, D’Amario D, Biondi-Zoccai G, Celia AI, et al. Combining Colchicine and Antiplatelet Therapy to Tackle Atherothrombosis: A Paradigm in Transition? International Journal of Molecular Sciences. 2025; 26(3):1136. https://doi.org/10.3390/ijms26031136

Chicago/Turabian Style

Giordano, Salvatore, Marina Camera, Marta Brambilla, Gianmarco Sarto, Luigi Spadafora, Marco Bernardi, Antonio Iaconelli, Domenico D’Amario, Giuseppe Biondi-Zoccai, Alessandra Ida Celia, and et al. 2025. "Combining Colchicine and Antiplatelet Therapy to Tackle Atherothrombosis: A Paradigm in Transition?" International Journal of Molecular Sciences 26, no. 3: 1136. https://doi.org/10.3390/ijms26031136

APA Style

Giordano, S., Camera, M., Brambilla, M., Sarto, G., Spadafora, L., Bernardi, M., Iaconelli, A., D’Amario, D., Biondi-Zoccai, G., Celia, A. I., Tremoli, E., Frati, G., Angiolillo, D. J., Sciarretta, S., & Galli, M. (2025). Combining Colchicine and Antiplatelet Therapy to Tackle Atherothrombosis: A Paradigm in Transition? International Journal of Molecular Sciences, 26(3), 1136. https://doi.org/10.3390/ijms26031136

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