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Advances in Antithrombotic Therapy in Cardiovascular Medicine
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Advances in Antithrombotic Therapy in Cardiovascular Medicine

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 20 September 2026 | Viewed by 1464

Special Issue Editors

Dr. Daniele Giacoppo

E-Mail Website
Guest Editor
Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico-San Marco”, University of Catania, 95124 Catania, Italy
Interests: percutaneous coronary intervention; myocardial infarction; coronary artery disease; vascular imaging; angiography
Special Issues, Collections and Topics in MDPI journals
Dr. Antonio Greco

E-Mail Website
Guest Editor
A.O.U. Policlinico “G. Rodolico-S. Marco”, University of Catania, 95123 Catania, Italy
Interests: thrombosis; coronary artery disease; coagulation; percutaneous coronary interventions

Special Issue Information

Dear Colleagues,

Antithrombotic therapy represents a cornerstone of cardiovascular medicine and is going through continuous evolution driven by advances in pharmacology, clinical trial evidence, and refined patient stratification. While antiplatelet and anticoagulant agents have dramatically reduced ischemic events across the spectrum of cardiovascular diseases—from acute coronary syndromes (ACSs) to atrial fibrillation and peripheral artery disease—their use remains challenged by a delicate balance between ischemic protection and bleeding risk.

In recent years, major efforts have been made to tailor antithrombotic regimens to the individual patient, moving away from a “one-size-fits-all” approach. This includes strategies for antiplatelet therapy modulation, consisting of different strategies to escalate or de-escalate the intensity of antiplatelet therapy. At the same time, novel agents such as factor XI inhibitors or subcutaneous P2Y12 receptor inhibitors are at different stages of clinical investigation, aiming to optimize the trade-off between ischemia and bleeding.

This Special Issue will cover key advances in the field of antithrombotic therapy in cardiovascular medicine, including antiplatelet therapy in coronary artery disease and modulation strategies, antithrombotic strategies in high-risk or complex PCI, and emerging pharmacological agents targeting thrombosis and coagulation. Special attention will also be given to the management of bleeding complications, perioperative antithrombotic strategies, and the implementation of guideline recommendations.

Dr. Daniele Giacoppo
Dr. Antonio Greco
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anticoagulant
  • antiplatelet
  • antithrombotic therapy
  • cardiovascular pharmacotherapy
  • coronary artery disease
  • in-flammation
  • lipid-lowering drugs
  • lipid metabolism
  • residual cardiovascular risk
  • thrombosis

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Published Papers (3 papers)

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Research

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15 pages, 808 KB  
Article
Proton Pump Inhibitor Use and Clinical Outcomes in Atrial Fibrillation During Anticoagulation
by Do-Young Kim, Hye Young Lee, Eileen Laurel Yoon, Seung-Young Roh and Kwang-No Lee
J. Clin. Med. 2026, 15(10), 3590; https://doi.org/10.3390/jcm15103590 - 8 May 2026
Viewed by 207
Abstract
Purpose: Proton pump inhibitors are commonly used during oral anticoagulant therapy in patients with atrial fibrillation, but evidence regarding outcomes beyond upper gastrointestinal bleeding remains limited. We evaluated whether concomitant proton pump inhibitor use during oral anticoagulant therapy was associated with thromboembolic [...] Read more.
Purpose: Proton pump inhibitors are commonly used during oral anticoagulant therapy in patients with atrial fibrillation, but evidence regarding outcomes beyond upper gastrointestinal bleeding remains limited. We evaluated whether concomitant proton pump inhibitor use during oral anticoagulant therapy was associated with thromboembolic events, bleeding outcomes, and all-cause mortality. Methods: This retrospective multicenter cohort study included patients with atrial fibrillation who initiated oral anticoagulant therapy. Concomitant proton pump inhibitor use was modeled as a time-varying exposure with a prespecified 7-day lag. The primary outcome was a composite of thromboembolic events, major bleeding, and all-cause mortality. Secondary outcomes included each component outcome and gastrointestinal bleeding. Associations were estimated using time-dependent Cox proportional hazard models after multiple imputation of missing baseline variables. Results: Among 11,203 patients (median age 71 years [interquartile range 62–78]; 4743 women [42.3%]), 7-day lagged time-varying proton pump inhibitor exposure was associated with a higher risk of the composite outcome (hazard ratio 1.29, 95% confidence interval 1.08–1.55), major bleeding (1.80, 1.36–2.37), gastrointestinal bleeding (1.77, 1.18–2.66), and all-cause mortality (1.58, 1.00–2.48). No statistically significant association was observed for thromboembolic events. Across robustness analyses, the overall pattern was broadly maintained, although estimates varied according to exposure timing. Conclusions: In this observational cohort of patients with atrial fibrillation receiving oral anticoagulant therapy, concomitant proton pump inhibitor use modeled with a 7-day lagged time-varying framework was associated with higher risks of several bleeding-related outcomes and all-cause mortality, but not thromboembolism. These findings should be interpreted as associations rather than causal effects. Full article
(This article belongs to the Special Issue Advances in Antithrombotic Therapy in Cardiovascular Medicine)
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23 pages, 5342 KB  
Article
Association Between DOAC Exposure and Lower-Extremity Arterial Calcification: A Propensity-Matched Exploratory CT Study
by Eniko Pomozi, Dora Zoe Zatyko, Ferenc Imre Suhai and Zoltan Szeberin
J. Clin. Med. 2026, 15(9), 3399; https://doi.org/10.3390/jcm15093399 - 29 Apr 2026
Viewed by 211
Abstract
Background: Lower limb arterial calcification (LLAC) is a robust imaging biomarker of peripheral artery disease (PAD) severity. Vitamin K antagonists are presumed to accelerate cardiovascular calcification. Direct oral anticoagulants (DOACs) may influence vascular calcification differently, but lower limb data are limited. Methods [...] Read more.
Background: Lower limb arterial calcification (LLAC) is a robust imaging biomarker of peripheral artery disease (PAD) severity. Vitamin K antagonists are presumed to accelerate cardiovascular calcification. Direct oral anticoagulants (DOACs) may influence vascular calcification differently, but lower limb data are limited. Methods: We performed a single-center retrospective cross-sectional study comparing LLAC on clinically acquired non-contrast CT between DOAC users and controls without anticoagulation. Patients were propensity score-matched 1:1 (48 DOAC vs. 48 control; n = 96) using baseline clinical covariates. Associations between LLAC scores and perioperative or cardiovascular events were assessed. Segment-specific LLAC was quantified on non-contrast CT and normalized for arterial segment length. A prespecified exposure–duration sensitivity analysis compared the outcomes in patients with ≥5 years of continuous DOAC therapy (n = 22) versus matched controls. Results: In the matched cohort, total LLAC scores did not differ significantly between DOAC and control groups (infrarenal aorta: median 7596.0 vs. 8637.0 (p = 0.487), iliac segment: median 5689.5 vs. 5193.5 (p = 0.602). However, in patients with ≥5 years of DOAC use, LLAC scores were significantly lower in proximal segments: infrarenal aorta median 5593.5 vs. 11,185.0 (p = 0.001997) and iliac arteries 5624.5 vs. 11,501.0 (p = 0.001867)). Higher LLAC was associated with major adverse cardiovascular events (such as myocardial infarction, stroke, or significant bleeding) in controls (p = 0.0023) but not in DOAC-treated patients. Conclusions: In this propensity-matched, cross-sectional CT study, long-term DOAC exposure was associated with lower proximal LLAC scores in a small duration-defined subgroup, while the primary matched analysis showed no overall difference in total LLAC scores. Because baseline (pre-DOAC) imaging was unavailable and residual confounding/survivor bias is possible, these findings should be considered hypothesis-generating and require prospective validation. The cohort reflected a mixed lower-extremity vascular population rather than exclusively classic chronic atherosclerotic PAD, which may limit biological interpretation and generalizability. Full article
(This article belongs to the Special Issue Advances in Antithrombotic Therapy in Cardiovascular Medicine)
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Review

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28 pages, 11290 KB  
Review
Anti-Thrombotic Therapy Following Transcatheter Structural Heart Intervention
by Francesco Tartaglia, Giulia Antonelli, Alessandro Gabrielli, Mauro Gitto, Arif A. Khokhar, Francesca Soriente, Pier Pasquale Leone, Damiano Regazzoli, Ole de Backer, Antonio Mangieri and Giulio Stefanini
J. Clin. Med. 2026, 15(8), 3175; https://doi.org/10.3390/jcm15083175 - 21 Apr 2026
Viewed by 665
Abstract
Transcatheter structural heart interventions, including aortic, mitral and tricuspid valve replacement or repair, and patent foramen ovale, atrial septal defect, and left atrial appendage closure, have dramatically expanded over the past two decades, providing substantial improvements in both clinical outcomes and quality of [...] Read more.
Transcatheter structural heart interventions, including aortic, mitral and tricuspid valve replacement or repair, and patent foramen ovale, atrial septal defect, and left atrial appendage closure, have dramatically expanded over the past two decades, providing substantial improvements in both clinical outcomes and quality of life. These interventions are performed in a high-risk patient population, which is at risk for both thrombotic and bleeding complications. The introduction of prosthetic devices into the arterial or venous circulation under heterogeneous hemodynamic conditions inevitably increases the risk for thrombotic events and thromboembolic complications. Consequently, the selection of antithrombotic therapy (AT) regimen and its duration is complex and should be tailored to each patient’s risk profile, balancing the expected risk and benefits. This state-of-the-art review critically examines the thrombotic risks inherent to transcatheter structural heart interventions, synthesizes available evidence and current guidelines recommendations on antithrombotic management, and defines persisting gaps in knowledge while discussing the most relevant ongoing clinical trials. Full article
(This article belongs to the Special Issue Advances in Antithrombotic Therapy in Cardiovascular Medicine)
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