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Direct Oral Anticoagulants in Addition to Anti platelet Therapy for Secondary Prevention After Acute Coronary Syndromes

A Systematic Review and Meta-analysis

Patients with acute coronary syndrome (ACS) remain at high risk for experiencing recurrent ischemic events. Direct oral anticoagulants (DOAC) have been proposed for secondary prevention after ACS.

Thrombosis prevention with antithrombotic agents plays a pivotal role in the treatment of patients with ACS. Dual anti platelet therapy (APT) after mechanical reperfusion with primary percutaneous coronary intervention (PCI) represents the standard of care for patients with ACS. Prior to the implementation of dual APT and PCI as the treatment of choice, vitamin K antagonists have been widely investigated with conflicting findings.

In this systematic review and meta-analysis of 6 trials comprising 29 667 patients, direct oral anticoagulants with APT was associated with a reduced risk of ischemic events at the cost of an increase in major bleedings compared with APT alone. Direct oral anticoagulants was associated with a reduction in ischemic events after ST-segment elevation myocardial infarction with no effects after non–ST-segment elevation ACS, while the increased risk of major bleeding was consistent after ST-segment elevation myocardial infarction and non–ST-segment elevation ACS.

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