DOACs and Atherosclerotic Cardiovascular Disease Management: Can We Find the Right Balance Between Efficacy and Harm.

Abstract

PURPOSE OF REVIEW:

The balance between efficacy and harm remains a challenge in the adoption of non-vitamin K antagonist direct oral anticoagulants (DOACs) for secondary atherosclerotic disease prevention. We provide a comprehensive review of the evidence for and against the addition of DOACs to the current management of atherosclerotic cardiovascular disease, including stable coronary artery disease (CAD), acute coronary syndrome (ACS), peripheral artery disease (PAD), and percutaneous coronary interventions (PCI).

RECENT FINDINGS:

The DOAC class exerts pleiotropic effects on atherosclerotic progression through coagulation and inflammatory pathways. In ACS, low-dose DOAC provides no added efficacy in the setting of dual antiplatelet therapy; however, full-dose DOAC increases bleeding. Efficacy-safety profile favor use of low-dose rivaroxaban in select stable CAD or PAD patients. Atrial fibrillation patients undergoing PCI resort to dual therapy with DOAC due to prohibitory bleeding with triple anti-thrombotic therapy. Evidence favors DOAC use in CAD and PAD; however, careful individual considerations must be undertaken.

• Authors: Feng Gao, Faisal Rahman
• Journal: Current atherosclerosis reports (Curr Atheroscler Rep) Vol. 24 Issue 6 Pg. 457-469 (06 2022) ISSN: 1534-6242 [Electronic] United States
• PMID: 35386093 (Publication Type: Journal Article, Review)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors

Topics

• Acute Coronary Syndrome (complications)
• Administration, Oral
• Anticoagulants (adverse effects)
• Atherosclerosis (etiology)
• Atrial Fibrillation (complications)
• Coronary Artery Disease (complications)
• Hemorrhage (chemically induced)
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Aggregation Inhibitors (adverse effects)