Parker, W.A.E. orcid.org/0000-0002-7822-8852, Gorog, D.A., Geisler, T. et al. (4 more authors) (2020) Prevention of stroke in patients with chronic coronary syndromes or peripheral arterial disease. European Heart Journal Supplements, 22 (Supplement_M). M26-M34. ISSN 1520-765X
Abstract
Stroke is a common and devastating condition caused by atherothrombosis, thromboembolism, or haemorrhage. Patients with chronic coronary syndromes (CCS) or peripheral artery disease (PAD) are at increased risk of stroke because of shared pathophysiological mechanisms and risk-factor profiles. A range of pharmacological and non-pharmacological strategies can help to reduce stroke risk in these groups. Antithrombotic therapy reduces the risk of major adverse cardiovascular events, including ischaemic stroke, but increases the incidence of haemorrhagic stroke. Nevertheless, the net clinical benefits mean antithrombotic therapy is recommended in those with CCS or symptomatic PAD. Whilst single antiplatelet therapy is recommended as chronic treatment, dual antiplatelet therapy should be considered for those with CCS with prior myocardial infarction at high ischaemic but low bleeding risk. Similarly, dual antithrombotic therapy with aspirin and very-low-dose rivaroxaban is an alternative in CCS, as well as in symptomatic PAD. Full-dose anticoagulation should always be considered in those with CCS/PAD and atrial fibrillation. Unless ischaemic risk is particularly high, antiplatelet therapy should not generally be added to full-dose anticoagulation. Optimization of blood pressure, low-density lipoprotein levels, glycaemic control, and lifestyle characteristics may also reduce stroke risk. Overall, a multifaceted approach is essential to best prevent stroke in patients with CCS/PAD.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 The Author(s). This is an author-produced version of a paper subsequently published in European Heart Journal Supplements. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Stroke; Myocardial infarction; Coronary artery disease; Peripheral arterial disease; Antiplatelet drugs; Anticoagulant drugs; Aspirin; Clopidogrel; Ticagrelor; rivaroxaban |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number British Heart Foundation FS/18/49/33752 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 17 Dec 2020 10:21 |
Last Modified: | 06 Dec 2021 01:38 |
Status: | Published |
Publisher: | Oxford University Press (OUP) |
Refereed: | Yes |
Identification Number: | 10.1093/eurheartj/suaa165 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:169128 |