How to optimize treatment in patients with different forms of coronary artery disease

Abstract

Coronary artery disease (CAD) retains top positions in terms of morbidity and mortality both in our country and many countries of the world. CAD takes many acute and chronic clinical forms and can be observed in patients with various cardiac and extracardiac pathologies. The therapy should be personalized to improve the prognosis for each patient with CAD. The COMPASS trial showed that administration of rivaroxaban at a dose of 2.5 mg twice daily combined with a longterm use of acetylsalicylic acid is reasonable in patients with stable coronary artery disease, a high risk of thrombotic complications and a low risk of bleeding to prevent the development of atherothrombotic cardiovascular events. The clinical benefit of this combination therapy is especially high in patients with diabetes mellitus. Once the percutaneous coronary intervention (PCI) is performed in a patient with CAD and atrial fibrillation (AF), we face the task to minimize the risk of atherothrombotic events, including the possibility of stent thrombosis, and the development of ischemic stroke, given the increased risk of bleeding due to such therapy. The results of PIONEER AF-PCI trial have become the  grounds for recommendation of rivaroxaban 15 mg as part of combination antithrombotic therapy for this group of  patients with AF. An option to add rivaroxaban to therapy may be considered in the presence of sinus rhythm in patients with reduced left ventricular ejection fraction and high thromboembolic risk to reduce the incidence of neurological events, as was shown in the COMMANDER HF trial. So there is a wealth of evidence that rivaroxaban may be used as an important component of the combination therapy of patients with CAD in a variety of clinical situations.