New Paradigms in Antithrombotic Strategies: A Leap into the Future of Cardiovascular Medicine

ABSTRACT

Among these, atrial fibrillation (AF), venous thromboembolism (VTE) and ischemic heart disease (IHD) have seen major developments, which have also been reflected by guidelines and changes in clinical practice [1,2,3]. Since the introduction of nonvitamin K antagonist oral anticoagulants (NOACs), which represented the first large-scale paradigm shift in the treatment of thrombotic diseases, research has focused on the unmet need for safer and effective anticoagulation, especially in those patients who are at higher risk of thrombotic and haemorrhagic events. A systematic review and meta-analysis of 31 studies showed how new-onset AF represents a common complication in COVID-19 patients, being found in up to 8% of hospitalized patients, and also showed that AF is associated with a significant increase in the risk of all-cause mortality [5]. [...]Protasiewicz et al. reported a retrospective analysis on the impact of anticoagulation before the SARS-CoV-2 infection on the clinical course and outcome of COVID-19;while being limited by low statistical power, the authors did not find any statistically significant difference according to the anticoagulation status [11]. [...]Zerah and colleagues described treatment patterns for antithrombotic combinations using a nationwide French database and showed how a significant proportion of the combinations was inappropriately prescribed or noncompliant with international guideline recommendations, with an unsurprising impact on the risk of major bleeding during follow-up [18].