Dual-pathway inhibition for secondary and tertiary antithrombotic prevention in cardiovascular disease

Davide Capodanno, Deepak L. Bhatt, John W. Eikelboom, Keith A.A. Fox, Tobias Geisler, C. Michael Gibson, Jose Ramon Gonzalez-Juanatey, Stefan James, Renato D. Lopes, Roxana Mehran, Gilles Montalescot, Manesh Patel, P. Gabriel Steg, Robert F. Storey, Pascal Vranckx, Jeffrey I. Weitz, Robert Welsh, Uwe Zeymer, Dominick J. Angiolillo

Research output: Contribution to journalReview articlepeer-review

84 Scopus citations


Advances in antiplatelet therapies for patients with cardiovascular disease have improved patient outcomes over time, but the challenge of balancing the risks of ischaemia and bleeding remains substantial. Moreover, many patients with cardiovascular disease have a residual risk of ischaemic events despite receiving antiplatelet therapy. Therefore, novel strategies are needed to prevent clinical events through mechanisms beyond platelet inhibition and with an acceptable associated risk of bleeding. The advent of non-vitamin K antagonist oral anticoagulants, which attenuate fibrin formation by selective inhibition of factor Xa or thrombin, has renewed the interest in dual-pathway inhibition strategies that combine an antiplatelet agent with an anticoagulant drug. In this Review, we highlight the emerging pharmacological rationale and clinical development of dual-pathway inhibition strategies for the prevention of atherothrombotic events in patients with different manifestations of cardiovascular disease, such as coronary artery disease, cerebrovascular disease and peripheral artery disease.

Original languageEnglish
Pages (from-to)242-257
Number of pages16
JournalNature Reviews Cardiology
Issue number4
StatePublished - 1 Apr 2020


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