Prevention of stroke in patients with chronic coronary syndromes or peripheral arterial disease
Parker, William A.E. (University of Sheffield)
Gorog, Diana A. (University of Hertfordshire)
Geisler, Tobias (University of Tübingen)
Vilahur, Gemma (Institut d'Investigació Biomèdica Sant Pau)
Sibbing, Dirk (Medizinische Klinik und Poliklinik I. Campus Großhadern)
Rocca, Bianca (Catholic University School of Medicine)
Storey, Robert F. (University of Sheffield)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Stroke is a common and devastating condition caused by atherothrombosis, thromboembolism, or haemorrhage. Patients with chronic coronary syndromes (CCS) or peripheral artery disease (PAD) are at increased risk of stroke because of shared pathophysiological mechanisms and risk-factor profiles. A range of pharmacological and non-pharmacological strategies can help to reduce stroke risk in these groups. Antithrombotic therapy reduces the risk of major adverse cardiovascular events, including ischaemic stroke, but increases the incidence of haemorrhagic stroke. Nevertheless, the net clinical benefits mean antithrombotic therapy is recommended in those with CCS or symptomatic PAD. Whilst single antiplatelet therapy is recommended as chronic treatment, dual antiplatelet therapy should be considered for those with CCS with prior myocardial infarction at high ischaemic but low bleeding risk. Similarly, dual antithrombotic therapy with aspirin and very-low-dose rivaroxaban is an alternative in CCS, as well as in symptomatic PAD. Full-dose anticoagulation should always be considered in those with CCS/PAD and atrial fibrillation. Unless ischaemic risk is particularly high, antiplatelet therapy should not generally be added to full-dose anticoagulation. Optimization of blood pressure, low-density lipoprotein levels, glycaemic control, and lifestyle characteristics may also reduce stroke risk. Overall, a multifaceted approach is essential to best prevent stroke in patients with CCS/PAD.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Anticoagulant drugs ; Antiplatelet drugs ; Aspirin ; Clopidogrel ; Coronary artery disease ; Myocardial infarction ; Peripheral arterial disease ; Rivaroxaban ; Stroke ; Ticagrelor
Publicat a:	European heart journal supplements, Vol. 22 (2021) , p. M26-M34, ISSN 1554-2815

DOI: 10.1093/EURHEARTJ/SUAA165
PMID: 33664637

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