Mattia Galli, MD Cardiologist Research Fellow at University of Florida College of Medicine-Jacksonville, USA Doctorate Programme in Clinical, Cellular and Molecular Research at Catholic University of the Sacred Heart, Rome, Italy
Thrombosis and Haemostasis
Author Interview
Cellular Haemostasis and Platelets
Galli et al.
Thromb Haemost
DOI: 10.1055/a-1730-8725
T&H
Why did you (and your colleagues) write this paper? What was its main purpose?
MATTIA GALLI
A strategy of dual-pathway inhibition (DPI), combining vascular dose of rivaroxaban to antiplatelet therapy, reduces atherothrombotic events in patients with stable atherosclerotic disease. However, there are limited data on the pharmacodynamic (PD) effects of this strategy and how it compares to standard dual antiplatelet therapy (DAPT). We sought to explore PD profiles associated with adjunctive treatment of a vascular dose of rivaroxaban in patients with atherosclerotic disease on background of aspirin or DAPT, and compare these strategies to a standard DAPT.
T&H
What are the main conclusions?
MATTIA GALLI
Our PD observations suggest that, compared to DAPT, the use of vascular dose of rivaroxaban in adjunct to antiplatelet therapy not only provides effective antithrombotic effects but reduces thrombin generation. Moreover, our findings suggest that adding clopidogrel on top of a DPI strategy may increase the risk of bleeding without any significant impact on efficacy.
T&H
What are the paper's implications? - to the public? -to medical professionals?
MATTIA GALLI
The results of this study may have important clinical implications. Indeed, the lack of a direct comparison between DPI and DAPT has represented one of the main issues hindering the spread of a DPI strategy in clinical practice. These PD findings provide important information in this respect, but also expand on the effects of using clopidogrel on top of a DPI strategy.
T&H
Are the findings clinically significant? Should the findings change practice?
MATTIA GALLI
Considering the central role thrombin plays as mediator of the coagulation cascade, platelet activation and inflammatory pathways, DPI may represent a promising strategy in reducing ischemic recurrencies without any trade-off in antiplatelet activity compared to standard DAPT.
