Antiplatelet Therapy in the Management of Atherosclerotic Cardiovascular Disease

This scientific review examines current international consensus statements and guidelines on the use of antiplatelet and combined antithrombotic therapy for the primary and secondary prevention of atherosclerotic cardiovascular disease. The changing paradigm of acetylsalicylic acid (ASA) use in primary prevention is highlighted, including recommendations against its routine use, particularly in adults aged ≥70 years. Contemporary strategies for early de-escalation, switching, and shortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention are discussed, with a focus on reducing bleeding risk. Particular attention is given to extended antithrombotic protection and dual-pathway inhibition with ASA and low-dose rivaroxaban in patients with chronic coronary syndrome and peripheral artery disease of the lower extremities. Differentiated short-term DAPT regimens for the acute management of non-cardioembolic ischemic stroke and transient ischemic attack are described. In addition, strategies for the safe combination of antiplatelet agents with direct oral anticoagulants in patients with atrial fibrillation, as well as rational gastroprotection with proton pump inhibitors, are reviewed.

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