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Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease
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Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 9628

Special Issue Editor

Dr. Giuseppe De Luca

E-Mail Website
Guest Editor
1. Division of Cardiology, AOU “Policlinico G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98039 Messina, Italy
2. Division of Cardiology, Nuovo Galeazzi-Sant’Ambrogio Hospital, 20161 Milan, Italy
Interests: STEMI; platelet and antiplatelet therapies; coronary stenting; genetic polymorphisms; atherosclerosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Coronary heart disease (CAD) is one of the most threatening cardiovascular diseases to human health. How to choose the best antithrombotic regimen has always been the focus of clinical research. Antiplatelet drug cyclooxygenase inhibitor aspirin and adenosine diphosphate P2Y12 receptor blockers are currently the pillars for the prevention and treatment of cardiovascular and cerebrovascular diseases, especially in patients treated with coronary stenting.

Patients requiring combined anticoagulation and antiplatelet therapy are clinically difficult to manage, and the management of CAD patients with complex clinical features remains demanding due to the risk of ischemic and bleeding events, due to multiple comorbidities and/or complex interventional procedures. There is often a high risk associated, and the pros and cons of this intensive antithrombotic therapy need to be weighed. Therefore, consensus and clinical updates on antithrombotic therapy in patients with acute coronary syndrome and/or percutaneous coronary intervention needing oral anticoagolation, such as those with atrial fibrillation, are particularly important.

This Special Issue focuses on the problems in the clinical practice of anticoagulation and antiplatelet therapy in patients with different types of CAD and CAD complicated with AF, which is of great significance for guiding clinicians in diagnosis and treatment. We welcome contributions to these and related topics, including original research and commentary to inform readers of the latest progress.

Dr. Giuseppe De Luca
Guest Editor

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Keywords

  • platelet
  • anticoagulant therapy
  • antiplatelet therapy
  • coronary artery disease (CAD)
  • atrial fibrillation (AF)
  • thromboembolic events
  • myocardial ischemic
  • bleeding events
  • aspirin
  • clopidogrel
  • cardiovascular and cerebrovascular diseases
  • diagnosis and treatment

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Published Papers (4 papers)

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Research

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10 pages, 490 KiB  
Article
Long Stent Implantation on the Left Anterior Descending Coronary Artery at a Follow-Up of More Than Five Years
by Alessandro Sticchi, Concetta Tatali, Massimo Ferraro, Arif A. Khokhar, Alessandra Scoccia, Alberto Cereda, Marco Toselli, Francesco Gallo, Alessandra Laricchia, Antonio Mangieri, Francesco Grigioni, Gian Paolo Ussia, Francesco Giannini and Antonio Colombo
J. Clin. Med. 2024, 13(1), 210; https://doi.org/10.3390/jcm13010210 - 29 Dec 2023
Viewed by 1773
Abstract
Background: Stent implantation represents the standard of care in coronary intervention. While a short stent implanted on a focal lesion located on the left anterior descending artery (LAD) seems a reasonable alternative to an internal mammary implant, the same for long stents is [...] Read more.
Background: Stent implantation represents the standard of care in coronary intervention. While a short stent implanted on a focal lesion located on the left anterior descending artery (LAD) seems a reasonable alternative to an internal mammary implant, the same for long stents is still debated. Methods: We reported the long-term data of 531 consecutive patients who underwent Percutaneous Coronary Intervention (PCI) with long stents in two highly specialized centres. The main inclusion criteria were the implantation of stents longer than 30 mm on the LAD and a minimum follow-up (FU) of five years. The primary endpoint was mortality, and the secondary endpoints were any myocardial infarction (MI), target vessel and lesion revascularization (TVR and TLR, respectively), and stent thrombosis (ST) observed as definite, probable, or possible. Results: In this selected population with characteristics of complex PCI (99.1%), the long-term follow-up (mean 92.18 ± 35.5 months) estimates of all-cause death, cardiovascular death, and any myocardial infarction were 18.3%, 10.5%, and 9.3%, respectively. Both all-cause and cardiovascular deaths are significantly associated with three-vessel disease (HR 6.8; confidence of interval (CI) 95% 3.844–11.934; p < 0.001, and HR 4.7; CI 95% 2.265–9.835; p < 0.001, respectively). Target lesion (TLR) and target vessel revascularization (TVR) are associated with the presence of three-lesion disease on the LAD (HR 3.4; CI 95% 1.984–5.781; p < 0.001; HR 3.9 CI 95% 2.323–6.442; p < 0.001, respectively). Re-PCI for any cause occurred in 31.5% of patients and shows an increased risk for three-lesion stenting (HR 4.3; CI 95% 2.873–6.376; p < 0.001) and the treatment of bifurcation with two stents (HR 1.6; 95% CI 1.051–2.414; p = 0.028). Stent thrombosis rate at the 5-year FU was 4.4% (1.3% definite; 0.9% probable; 2.1% possible), including a 1.7% rate of very-late thrombosis. The stent length superior to 40 mm was not associated with poor outcomes (all-cause death p = 0.349; cardiovascular death p = 0.855; MI p = 0.691; re-PCI p = 0.234; TLR p = 0.805; TVR p = 0.087; ST p = 0.189). Conclusion: At an FU of longer than five years, patients treated with stents longer than 30 mm in their LAD showed acceptable procedural results but poor outcomes. Full article
(This article belongs to the Special Issue Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease)
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Review

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18 pages, 923 KiB  
Review
Relationships, Current Issues, Safety and Efficacy of Oral Anticoagulation in Cancer Patients with Atrial Fibrillation
by Antonio Gabriele Franchina, Matteo Rocchetti, Elena Sala, Alessandra Laricchia, Alessandro Minardi, Andrea Spangaro, Marco Guazzi, Stefano Lucreziotti and Alberto Cereda
J. Clin. Med. 2023, 12(20), 6559; https://doi.org/10.3390/jcm12206559 - 16 Oct 2023
Cited by 1 | Viewed by 2218
Abstract
A relationship between malignancy and impaired hemostasis has been proven, and balancing clotting and bleeding risks can be challenging. Half of cancer patients with atrial fibrillation (AF) do not receive any oral anticoagulation (OAC). Using PubMed on the relationship between cancer and AF [...] Read more.
A relationship between malignancy and impaired hemostasis has been proven, and balancing clotting and bleeding risks can be challenging. Half of cancer patients with atrial fibrillation (AF) do not receive any oral anticoagulation (OAC). Using PubMed on the relationship between cancer and AF and their association with hemostasis, targeting studies comparing vitamin K antagonists (VKAs) and direct OAC (DOAC) strategies in AF cancer patients, three RCTs (>3000 patients) and eight observational studies (>250,000 patients) comparing different OACs were retrieved. The VKA prescribed was always warfarin. Dabigatran was the only DOAC not analyzed in the RCTs but the most used in non-randomized studies, whereas edoxaban-treated patients were the majority in the RCTs. Overall, the DOAC patients showed similar or lower rates of efficacy (thromboembolic) and safety (bleeding) outcomes compared to the VKA patients. DOACs are subject to fewer interactions with antineoplastic agents. DOACs may be preferable to VKAs as a thromboembolic prophylaxis in cancer patients with non-valvular AF. Full article
(This article belongs to the Special Issue Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease)
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23 pages, 1610 KiB  
Review
Platelets and the Atherosclerotic Process: An Overview of New Markers of Platelet Activation and Reactivity, and Their Implications in Primary and Secondary Prevention
by Matteo Nardin, Monica Verdoia, Davide Cao, Simone Nardin, Elvin Kedhi, Gennaro Galasso, Arnoud W. J. van ‘t Hof, Gianluigi Condorelli and Giuseppe De Luca
J. Clin. Med. 2023, 12(18), 6074; https://doi.org/10.3390/jcm12186074 - 20 Sep 2023
Cited by 5 | Viewed by 2616
Abstract
The key role played by platelets in the atherosclerosis physiopathology, especially in the acute setting, is ascertained: they are the main actors during thrombus formation and, thus, one of the major investigated elements related to atherothrombotic process involving coronary arteries. Platelets have been [...] Read more.
The key role played by platelets in the atherosclerosis physiopathology, especially in the acute setting, is ascertained: they are the main actors during thrombus formation and, thus, one of the major investigated elements related to atherothrombotic process involving coronary arteries. Platelets have been studied from different points of view, according with the technology advances and the improvement in the hemostasis knowledge achieved in the last years. Morphology and reactivity constitute the first aspects investigated related to platelets with a significant body of evidence published linking a number of their values and markers to coronary artery disease and cardiovascular events. Recently, the impact of genetics on platelet activation has been explored with promising findings as additional instrument for patient risk stratification; however, this deserves further confirmations. Moreover, the interplay between immune system and platelets has been partially elucidated in the last years, providing intriguing elements that will be basic components for future research to better understand platelet regulation and improve cardiovascular outcome of patients. Full article
(This article belongs to the Special Issue Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease)
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Other

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14 pages, 2174 KiB  
Systematic Review
Efficacy and Safety of Direct Oral Anticoagulants versus Warfarin in Obese Patients (BMI ≥ 30 kg/m2) with Atrial Fibrillation or Venous Thromboembolism: An Updated Systematic Review and Meta-Analysis
by Paschalis Karakasis, Nikolaos Ktenopoulos, Konstantinos Pamporis, Marios Sagris, Stergios Soulaidopoulos, Maria Gerogianni, Ioannis Leontsinis, George Giannakoulas, Dimitris Tousoulis, Nikolaos Fragakis and Konstantinos Tsioufis
J. Clin. Med. 2024, 13(13), 3784; https://doi.org/10.3390/jcm13133784 - 27 Jun 2024
Cited by 1 | Viewed by 2393
Abstract
Background: Real-world data show limited utilization of direct oral anticoagulants (DOACs) in obese patients (body mass index [BMI] ≥ 30 kg/m2) due to concerns regarding their efficacy and safety in this demographic. Aim: This review aimed to consolidate current [...] Read more.
Background: Real-world data show limited utilization of direct oral anticoagulants (DOACs) in obese patients (body mass index [BMI] ≥ 30 kg/m2) due to concerns regarding their efficacy and safety in this demographic. Aim: This review aimed to consolidate current evidence on the efficacy and safety of DOACs versus warfarin in obese patients with non-valvular atrial fibrillation (AF) or venous thromboembolism (VTE). The primary efficacy outcome assessed a composite of all-cause mortality, stroke, systemic embolism (SE), and myocardial infarction (MI). Methods: A systematic search was conducted in MEDLINE, SCOPUS, and Cochrane databases from inception to December 28, 2023. Data were synthesized using random-effects meta-analysis. Results: A total of 35 studies involving 434,320 participants were analyzed. DOAC use was associated with a significant reduction in the risk of the composite outcome (RR = 0.80, 95% CI [0.65, 0.98], I2 = 95%), hemorrhagic stroke (RR = 0.58, 95% CI [0.38, 0.88], I2 = 92%), major bleeding (RR = 0.76, 95% CI [0.63, 0.92], I2 = 94%), gastrointestinal bleeding (RR = 0.59, 95% CI [0.49, 0.72], I2 = 88%), and intracranial bleeding (RR = 0.45, 95% CI [0.34, 0.60], I2 = 44%) compared to warfarin. A non-significant benefit of DOACs was observed for all-cause mortality, MI, the composite of stroke or SE, ischemic stroke, SE, VTE, and minor bleeding compared to warfarin. Subgroup analysis indicated no significant effect modification based on the indication for anticoagulation or study design. Conclusions: DOACs demonstrated a favorable efficacy and safety profile in obese individuals compared to warfarin. Full article
(This article belongs to the Special Issue Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease)
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