The potential role of anticoagulant therapy for the secondary prevention of ischemic events post-acute coronary syndrome

Abstract

The use of dual antiplatelet therapy has led to a substantial reduction in ischemic events post-acute coronary syndrome (ACS). Despite this, recurrent event rates remain high. Recent research has combined antiplatelet with anticoagulant therapy to reduce recurrent event rates further. Compared with standard medical therapy, rivaroxaban demonstrated improved efficacy outcomes and significantly reduced mortality after an ACS. Although clear benefits of novel oral anticoagulants post-ACS have been proven, concerns regarding bleeding are still a barrier to widespread use. This review explores key trials of dual antiplatelet therapy and examines the latest research in anticoagulation aiming to optimize clinical outcomes post-ACS.

Keywords::

• ACS
• Acute coronary syndrome
• Anticoagulants
• Antiplatelets
• Rivaroxaban

Transparency

Declaration of funding

Editorial support for this manuscript was funded by Bayer HealthCare Pharmaceuticals and Janssen Scientific Affairs LLC.

Declaration of financial/other relationships

A.C.C. and K.E.W.-S. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. C.H. has disclosed that he has received support to attend advisory boards and international conferences, and speaker honoraria from AstraZeneca, Lilly, Boehringer Ingelheim and Bayer. P.E.A. has disclosed that he has received research support and honoraria for attendance at advisory boards from Bayer, J&J, Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, AstraZeneca, Sanofi Aventis, The Medicine Company and Merck.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors acknowledge Abigail Macleod, who provided editorial assistance with funding from Bayer HealthCare Pharmaceuticals and Janssen Scientific Affairs LLC.