Cardiology Journal (Jun 2025)
Extended dual antithrombotic therapy in patients with chronic coronary syndrome — which agent should be added to aspirin?
- Jacek Kubica,
- Piotr Adamski,
- Katarzyna Buszko,
- Piotr Buszman,
- Nader Elmasri,
- Tomasz Fabiszak,
- Jakub Foryś,
- Robert Gajda,
- Mariusz Gąsior,
- Robert Gil,
- Paweł Grzelakowski,
- Tomasz Hajdukiewicz,
- Miłosz Jaguszewski,
- Adam Kern,
- Wacław Kochmann,
- Jacek Konarski,
- Aldona Kubica,
- Tobiasz Kudla,
- Wiktor Kuliczkowski,
- Aleksandra Kusińska-Czyczyło,
- Ewa Laskowska,
- Przemysław Magielski,
- Piotr Michalski,
- Krzysztof Milewski,
- Natalia Mrzywka,
- Piotr Niezgoda,
- Małgorzata Ostrowska,
- Maciej Piasecki,
- Przemysław Podhajski,
- Janusz Prokopczuk,
- Jakub Ratajczak,
- Alicja Rzepka-Cholasińska,
- Grzegorz Skonieczny,
- Giuseppe Specchia,
- Łukasz Szarpak,
- Paweł Szymański,
- Małgorzata Topolska,
- Julia M. Umińska,
- Marcin Ziółkowski,
- Aleksander Żurakowski,
- Eliano Pio Navarese
Affiliations
- Jacek Kubica
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Piotr Adamski
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Katarzyna Buszko
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Piotr Buszman
- Centre for Cardiovascular Research and Development of American Heart of Poland, Katowice, Gruppo San Donato, Katowice Poland
- Nader Elmasri
- American Heart of Poland, Sztum, Poland
- Tomasz Fabiszak
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Jakub Foryś
- American Heart of Poland, Zgierz, Poland
- Robert Gajda
- Modern Medical Technologies Center, Torun, Poland
- Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
- Robert Gil
- Department of Cardiology, National Institute of Medicine Ministry of the Internal Affairs and Administration, Warsaw, Poland
- Paweł Grzelakowski
- Department of Cardiology and Cardiac Surgery, 10th Military Hospital and Polyclinic, Bydgoszcz, Poland
- Tomasz Hajdukiewicz
- Department of Cardiology, Provincial Hospital of Elblag, Poland
- Miłosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
- Adam Kern
- Department of Cardiology and Internal Medicine, University of Warmia and Mazury in Olsztyn, Poland
- Wacław Kochmann
- Department of Cardiovascular Disease, Centre of Postgraduate Medical Education, Warsaw, Poland
- Jacek Konarski
- American Heart of Poland, Pila, Poland
- Aldona Kubica
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Tobiasz Kudla
- American Heart of Poland, Kedzierzyn-Kozle, Poland
- Wiktor Kuliczkowski
- Clinical Department of Cardiology, Department of Cardiology, Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University
- Aleksandra Kusińska-Czyczyło
- American Heart of Poland, Kedzierzyn-Kozle, Poland
- Ewa Laskowska
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Przemysław Magielski
- Scientia Research Institute, Bydgoszcz, Poland
- Piotr Michalski
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Krzysztof Milewski
- American Heart of Poland, Bielsko-Biala, Poland
- Natalia Mrzywka
- American Heart of Poland, Pila, Poland
- Piotr Niezgoda
- ORCiD
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Małgorzata Ostrowska
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Maciej Piasecki
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Przemysław Podhajski
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Janusz Prokopczuk
- American Heart of Poland, Kedzierzyn-Kozle, Poland
- Jakub Ratajczak
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Alicja Rzepka-Cholasińska
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Grzegorz Skonieczny
- Clinical Department of Cardiology, The Ludwik Rydygier Provincial Polyclinical Hospital, Torun, Poland
- Giuseppe Specchia
- Profesor emeritus, Department of Cardiology, University of Pavia, Italy
- Łukasz Szarpak
- Department of Clinical Research and Development, LUXMED Group, Warsaw, Poland
- Paweł Szymański
- Regional Specialistic Hospital, Grudziadz, Poland
- Małgorzata Topolska
- American Heart of Poland, Katowice, Poland
- Julia M. Umińska
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Marcin Ziółkowski
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Aleksander Żurakowski
- Andrzej Frycz Modrzewski Krakow University, Poland
- Eliano Pio Navarese
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Sardinia Island, Italy
- DOI
- https://doi.org/10.5603/cj.104821
- Journal volume & issue
-
Vol. 32,
no. 3
Abstract
According to the 2024ESC Guidelines for the management of chronic coronary syndromes dual antithrombotic treatment comprising aspirin and a second antithrombotic drug for extended long-term prevention should be considered in patients at increased ischemic risk without high bleeding risk. However, no clear indications regarding the choice of a second antithrombotic agent are provided. It was therefore decided to discuss the available evidence regarding this issue. The guidelines provided the number needed to treat (NNT) and the number needed to harm (NNH) for each proposed medication. However, the presented data are misleading and may result in unjustified therapeutic decisions. Due to the great impact of this document on clinical practice all data provided in this document should be carefully verified and commented regarding limitations.
Keywords
- extended antithrombotic therapy
- chronic coronary syndrome
- rivaroxaban
- ticagrelor
- clopidogrel
- prasugrel
