Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 195

While the combination of aspirin and clopidogrel is beneficial for up to 1 year after MI or stent placement, this combination has not shown superiority to aspirin monotherapy in stable CAD and peripheral vascular disease (CHARISMA trial). However, in a substudy of CHARISMA, patients with prior MI appeared to derive a benefit from prolonged combination therapy for up to 28 months, especially if they had disease in multiple vascular locations (e.g., MI and PAD).³⁶ In monotherapy, clopidogrel is an alternative to aspirin and may be slightly superior in reducing coronary and cerebrovascular events with a slightly lower risk of GI bleed.³⁷

Patients with CAD who also have an indication for anticoagulation (AF or a history of DVT) are best treated with standalone anticoagulation beyond 1 year of MI or coronary stenting (warfarin or NOAC). Anticoagulation, per se, effectively reduces coronary events, as in the modern AFIRE trial using rivaroxaban;³⁸ in older trials, warfarin monotherapy or warfarin–aspirin combination was more effective than aspirin in preventing coronary events, at the cost of a higher bleeding risk.³⁹