The quest for safer antithrombotic treatment regimens in patients with coronary artery disease: new strategies and paradigm shifts

Introduction: Despite the undeniable benefits on reducing ischemic adverse events, antiplatelet regimens including dual antiplatelet therapy (DAPT) with aspirin and P2Y(12) receptor inhibitors are associated with an increased risk of bleeding. The awareness of the unfavorable prognostic implications associated with bleeding complications have somewhat hampered the enthusiasm towards the use of more potent antiplatelet treatment regimens or prolonged use of DAPT. This awareness also has prompted a series of investigations geared towards the identification of antithrombotic treatment regimens which are efficacious at reducing ischemic recurrences while also safe in terms of bleeding risk profile. Areas covered: The present manuscript focuses on new approaches for improving the safety profile of antithrombotic treatment regimens, including most recent updates from clinical trials, as well as future perspectives in the field. Expert commentary: Results of ongoing trials testing new antithrombotic treatment regimens, including new drugs, new combinations, which may be used for different duration of time according to the individual's risk of thrombotic and bleeding complications, may lead to paradigm shifts in secondary prevention of atherothrombotic events in patients with coronary artery disease.