Optimal Antithrombotic Regimens Across Atherosclerotic Vascular Beds: Toward Mechanism and Risk-Oriented Strategies.
| Title: | Optimal Antithrombotic Regimens Across Atherosclerotic Vascular Beds: Toward Mechanism and Risk-Oriented Strategies. |
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| Authors: | Sabouret P; Heart Institute and Action Group, Pitié-Salpétrière, Sorbonne University, 75013 Paris, France.; Giamundo DM; Department of Cardiology, Policlinico Casilino, 00168 Rome, Italy.; Costa F; Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy.; Capranzano P; Cardiology Division, Policlinico Hospital, University of Catania, 95124 Catania, Italy.; Spadafora L; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy.; Cacciatore S; Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.; Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, 00168 Rome, Italy.; González Aguado N; Área del Corazón, Hospital Universitario Virgen de La Victoria, 29010 Málaga, Spain.; Unidad de Insuficiencia Cardíaca y Cardiopatías Familiares, Cardiología, Hospital Universitario Virgen de La Victoria, 29010 Málaga, Spain.; Bernardi M; Department of Cardiology, Santa Maria Goretti, 04100 Latina, Italy.; Ibrahim A; Faculty of Medicine, Alexandria University, Alexandria 5424041, Egypt.; Abdelaziz A; Faculty of Medicine, Alexandria University, Alexandria 5424041, Egypt.; Alagna G; Cardiology Department, San Biagio Hospital, ASL VCO Distretto Sanitario di Verbania, 28922 Verbania, Italy.; Gragnano F; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', 80138 Naples, Italy.; Division of Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', 26100 Caserta, Italy.; Calabrò P; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', 80138 Naples, Italy.; Division of Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', 26100 Caserta, Italy.; Andò G; Azienda Ospedaliera Papardo, Contrada Papardo, 98158 Messina, Italy.; Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy. |
| Source: | Journal of clinical medicine [J Clin Med] 2026 Mar 18; Vol. 15 (6). Date of Electronic Publication: 2026 Mar 18. |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101606588 Publication Model: Electronic Cited Medium: Print ISSN: 2077-0383 (Print) Linking ISSN: 20770383 NLM ISO Abbreviation: J Clin Med Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Basel, Switzerland : MDPI AG, [2012]- |
| Abstract: | Arterial thrombosis emerges from the interplay between plaque disruption, platelet activation, and coagulation pathway amplification on a background of heterogeneous ischemic and bleeding risk. Optimal antithrombotic therapy therefore varies across clinical settings, from acute coronary syndromes (ACS) to chronic coronary syndromes (CCS), ischemic stroke, peripheral artery disease (PAD), and atrial fibrillation (AF) associated with atherosclerotic disease. Contemporary European and North American guidelines endorse an increasingly individualized approach, moving away from rigid "one-size-fits-all" dual antiplatelet therapy (DAPT) duration and intensity and incorporating dual pathway inhibition with low-dose rivaroxaban plus aspirin in selected high-risk CCS and PAD patients. In ischemic stroke, short-course DAPT is confined to minor events and transient ischemic attacks, whereas long-term monotherapy remains standard, and the coexistence of AF typically shifts the balance toward oral anticoagulation. Across all scenarios, antithrombotic benefit must be weighed against bleeding, especially in elderly, frail, or comorbid patients. Evidence gaps remain substantial, particularly in patients with overlapping vascular territories, AF plus atherosclerotic disease, and after ischemic stroke of complex or mixed mechanisms. This narrative review summarizes current evidence and guideline-based strategies in major atherosclerotic settings, proposes a unifying conceptual framework, and highlights key uncertainties and research directions for truly personalized antithrombotic care. |
| Contributed Indexing: | Keywords: anticoagulant; antiplatelet; antithrombotic therapy; atherosclerosis; precision medicine; vascular disease |
| Entry Date(s): | Date Created: 20260328 Date Completed: 20260328 Latest Revision: 20260330 |
| Update Code: | 20260422 |
| PubMed Central ID: | PMC13026836 |
| DOI: | 10.3390/jcm15062325 |
| PMID: | 41899248 |
| Database: | MEDLINE |
Journal Article; Review