Treatment of Ischemic Heart Disease After Previous Myocardial Infarction in Patients With Low Haemorrhagic Risk
Clinical Scenario
This protocol addresses patients with ischemic heart disease who have a history of previous myocardial infarction and have been assessed as being at low haemorrhagic risk. This selected sub-population is the focus of dedicated trial evidence evaluating intensified antithrombotic strategies.
Previous myocardial infarction
Low haemorrhagic risk
Treatment Approach — Partial Overview
In this selected population, evidence supports adding a second antithrombotic agent to aspirin. The full protocol specifies which agents qualify for use in this setting and under what clinical conditions each applies.
Complete agent selection, sequencing, and clinical criteria are available in the full protocol below →
References
DOI: 10.1093/eurheartj/suaa060
- Recently, the opportunity of a dual antiplatelet therapy in patients with post-infarct SIHD was evaluated in the PEGASUS trial: in selected (low haemorrhagic risk) patients the addition of ticagrelor 60 mg b.i.d. at 1–3 years after the acute event, it has allowed to save in 10 000 patients 42 cardiovascular events/year at the price of 31 TIMI major haemorrhages/year.
- In the COMPASS study, three antithrombotic regimens were compared in coronary heart disease patients (previous MI, angina, previous percutaneous, or surgical coronary revascularization): rivaroxaban 2.5 mg b.i.d. plus ASA, rivaroxaban 5 mg bid, ASA alone: a significant reduction in the combined primary endpoint (cardiovascular death, MI, and stroke) was observed in the ASA + rivaroxaban group: 347 (4%) out of 8313 vs. 460 (6%) out of 8261 (HR 0.74, 95% CI 0.65–0.86, P < 0.0001).
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