Optimal Medical Therapy for Chronic Coronary Disease in 2024: Focus on Antithrombotic Therapy

Med Clin North Am. 2024 May;108(3):489-507. doi: 10.1016/j.mcna.2023.11.004. Epub 2023 Dec 27.

Abstract

Antiplatelet therapy is the cornerstone of the secondary prevention of cardiovascular disease. Aspirin is indicated for all patients with chronic coronary disease to prevent recurrent ischemic events. A more potent antithrombotic therapy-including P2Y12 inhibitor monotherapy, dual antiplatelet therapy, or vascular dose anticoagulation-reduces the risk of ischemic events but also increases bleeding risk. Clinicians must weigh both ischemic risks and bleeding risks when determining an optimal antithrombotic therapy for patients with chronic coronary disease, and soliciting patient involvement in shared decision-making is critical.

Keywords: Antithrombotic therapy; Chronic coronary disease; Coronary artery disease.

Publication types

  • Review

MeSH terms

  • Aspirin / adverse effects
  • Aspirin / therapeutic use
  • Cardiovascular Diseases* / prevention & control
  • Chronic Disease
  • Coronary Disease*
  • Drug Therapy, Combination
  • Fibrinolytic Agents / therapeutic use
  • Heart Diseases*
  • Humans
  • Percutaneous Coronary Intervention*
  • Platelet Aggregation Inhibitors

Substances

  • Platelet Aggregation Inhibitors
  • Fibrinolytic Agents
  • Aspirin