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The Role of Direct Oral Anticoagulant in Patients with Acute Coronary Syndrome on Single or Dual Antiplatelet Regime: Review of Opportunities and Challenges

[ Vol. 15 , Issue. ]

Author(s):

Asim Ahmed Elnour*, András Komócsi, Péter Kupó, Israa Yousif El Khidir, Seeba Zachariah, Kishore Gnana, Sahar Asim and Adel Sadik Pages 1-12 (12)

Abstract:


Background: Despite the developments of single or dual antiplatelet therapy consisting of aspirin and/or clopidogrel, pra - sugrel or ticagrelor, post-acute coronary syndrome a room for potential improvement toward optimal prevention persist. Addition of a direct oral anticoagulant to the antiplatelet treatment of patients with acute coronary syndrome is clinically practiced in cases where anticoagulation is indicated by high thromboembolic risk.

Objective: The main objectives of this review, was to explore the role of supplementation with a direct oral anticoagulant to an - tiplatelet (aspirin or P2Y12 inhibitor) in patients with acute coronary syndrome.

Methods: We have searched the Medline, for studies involving direct oral anticoagulant use in acute coronary syndrome. We have reviewed specific relevant 9 meta-analyses between the years 2012 to 2019.

Results: Our review of nine meta-analyses has revealed that addition of direct oral anticoagulant to antiplatelet therapy compared with antiplatelet alone was beneficial about the composite end-points of major ischemic events in patients with acute coronary syndrome. Furthermore the combined regimen of single antiplatelet plus direct oral anticoagulant is as effective as the triple regimen of dual an - tiplatelet plus direct oral anticoagulant and results in less bleeding.

Conclusion: Cardiologists should balance the efficacy with higher risk of bleeding with more intensified DOAC therapy. Better risk characterization and timely adaptation of the regime to the patients need should be tested. Recurrent ischemic event and bleeding event risk scoring should guide individualized treatment.

Keywords:

Acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT), direct oral anticoagulant (DOAC), single antiplatelet therapy (SAPT).

Affiliation:

College of Pharmacy, Gulf Medical University, Ajman, Heart Centre, Medical School, University of Pécs, Pécs, Heart Centre, Medical School, University of Pécs, Pécs, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, College of Pharmacy, Gulf Medical University, Ajman, College of Pharmacy, Gulf Medical University, Ajman, Smile Dental Center, Dubai, Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain



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