Non-vitamin K antagonist oral anticoagulants in the treatment of coronary and peripheral atherosclerosis

Oral anticoagulants (OACs) are widely used for prevention of systemic thromboembolism, including the reduction of the risk of stroke in patients with atrial fibrillation (AF) and prosthetic heart valves. There is also an increasing population of patients who require not only OACs, but also double antiplatelet therapy (DAPT). A typical example is a patient with AF and stable coronary artery disease or acute coronary syndrome (ACS), treated by percutaneous coronary intervention. In recent years, with the introduction of NOACs, triple or dual therapy has become safer. Regardless of these indications for the use of NOACs, rivaroxaban at a reduced dose has proved to efficiently reduce the risk of further thrombotic events when added to DAPT in patients who have suffered an ACS. However, such therapy increases the incidence of bleeding complications. Interesting was also the potential impact of the pleiotropic mechanism of action of non-vitamin K antagonist oral anticoagulants (NOACs) through protease-activated receptors 1 and 2, present on the platelets and many other cells, and changing the course of arterial atherosclerosis. The COMPASS trial has shown that in the group treated with rivaroxaban combined with aspirin, the primary outcome (cardiovascular death, stroke, and myocardial infarction) occurred significantly less frequently than in the group treated only with aspirin. However, a significantly higher number of bleedings was observed. In the subgroup of patients with peripheral artery disease, a significant reduction of the incidence of amputations was shown. The outcomes of the COMPASS trial might be a breakthrough in the treatment of coronary and peripheral atherosclerosis.