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Antithrombotic therapy in patients with established atherosclerotic coronary disease
  1. Antonio Landi,
  2. Marco Valgimigli
  1. Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Università della Svizzera Italiana, Lugano, Switzerland
  1. Correspondence to Professor Marco Valgimigli, Cardiocentro Ticino, Lugano, Switzerland; marco.valgimigli{at}

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Learning objectives

  • Antithrombotic treatment strategies for secondary or tertiary prevention in patients with established coronary artery disease (CAD) should be tailored on the individual bleeding and ischaemic risk.

  • How concomitant comorbidities, individual ischaemic and bleeding risk profiles influence the composition and duration of antithrombotic therapy.

  • To be able to apply and interpret bleeding and ischaemic risk scores to optimally guide antithrombotic treatments.

  • To be able to select the best antithrombotic treatment based on the individual ischaemic and bleeding risk profile.

  • To apply an evidence-based approach in the composition and duration of antithrombotic therapy in patients with established CAD undergoing percutaneous coronary intervention.

  • To accurately use antithrombotic treatments in special and still debated scenarios such as patients undergoing coronary artery bypass grafting or medical treatment alone.


Antithrombotic therapy is the cornerstone of the pharmacological treatment in patients with established coronary artery disease (CAD).1 Despite technological improvements, the refinement of interventional strategies and more effective pharmacological treatments, patients with CAD remain at high risk of ischaemic recurrences at short-term and long-term. Although antithrombotic treatment intensification lowers ischaemic complications compared with less potent regimens, it increases the risk of major bleeding events which carry a similar or even worse prognostic impact than a recurrent myocardial infarction (MI).2 The mounting awareness of the prognostic relevance of bleeding complications led to some paradigm shifts in the antithrombotic treatment of patients with CAD.3 In the last decade, evidence continued to evolve and different treatment regimens in various combinations and durations have been tested in patients at high ischaemic and/or bleeding risk. However, the risk of adverse events in patients with CAD may not be uniform over time with the highest risk of ischaemic events in the first 1–3 months after the index event, followed by a slight prevalence of the bleeding risk over time4 …

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  • Contributors AL conceived the original idea and wrote the first draft of the manuscript. MV critically revised the manuscript and gave final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MV reports grants and/or personal fees from AstraZeneca, Terumo, Alvimedica/CID, Abbott Vascular, Daiichi Sankyo, Bayer, CoreFLOW, Idorsia Pharmaceuticals, Universität Basel Department Klinische Forschung, Vifor, Bristol-Myers Squibb, Biotronik, Boston Scientific, Medtronic, Vesalio, Novartis, Chiesi, PhaseBio.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.