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Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease: 2nd Edition

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Special Issue Information

Dear Colleagues,

We sincerely invite you to contribute to this Special Issue "Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease: 2nd Edition". The first edition is available at https://www.mdpi.com/journal/jcm/special_issues/4ZNJ8HNECK. This Special Issue combines original research and review papers with a focus on the recent advances in coronary artery disease.

Coronary artery disease (CAD) is one of the most significant threats to cardiovascular health, and the selection and optimization of antithrombotic therapy remains a core challenge in clinical practice. Antiplatelet therapy, represented by aspirin and P2Y12 receptor antagonists, is the cornerstone of secondary prevention of CAD and post-percutaneous coronary intervention (PCI) management. However, increasingly complex situations arise in clinical practice, particularly in patients with CAD complicated by atrial fibrillation who require long-term oral anticoagulation after stent placement. Balancing anticoagulation and antiplatelet therapy has become a thorny issue. Treatment for these patients requires reducing the risk of in-stent thrombosis, stroke, and other ischemic events while strictly preventing serious complications such as gastrointestinal or intracranial hemorrhage.

In recent years, with the accumulation of evidence regarding the use of new drugs and the continuous refinement of treatment strategies, clinical guidelines have been continuously updated, providing a clearer path for the individualized management of these high-risk patients. This Special Issue aims to gather the latest research progress and clinical practice experience in this field, focusing on key issues such as antithrombotic strategy selection, treatment course formulation, risk assessment, and complication prevention for patients with acute coronary syndrome and those undergoing PCI with anticoagulation indications. We welcome original research and review articles to jointly update and promote the progress of antithrombotic therapy for coronary artery disease.

Prof. Dr. Giuseppe De Luca
Guest Editor

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Keywords

platelet
anticoagulant therapy
antiplatelet therapy
coronary artery disease (CAD)
atrial fibrillation (AF)
thromboembolic events
myocardial ischemic
bleeding events
aspirin
clopidogrel
cardiovascular and cerebrovascular diseases
diagnosis and treatment
percutaneous coronary intervention
acute coronary syndrome

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11 pages, 470 KB

Open AccessArticle

Association Between Heparin Dose, Body Mass Index, and Stroke Risk in Patients Undergoing TAVR

by Ziad Arow, Juri Iwata, Akiko Masumoto, Arthur Clement, Laurent Lepage, Laurent Bonfils, Rawia Hussein-Aro, Abid Assali, Nicolas Dumonteil, Didier Tchetche and Chiara De Biase

J. Clin. Med. 2026, 15(3), 1201; https://doi.org/10.3390/jcm15031201 - 3 Feb 2026

Viewed by 685

Abstract

Background: Unfractionated heparin (UFH) is routinely administered during transcatheter aortic valve replacement (TAVR) to prevent thromboembolic complications. However, there are no clear evidence-based guidelines defining optimal heparin dosing or target activated clotting time (ACT) values. This study aimed to evaluate the association between intraprocedural UFH dosing, ACT values, and peri-procedural stroke risk in the overall population of patients undergoing TAVR, with a prespecified stratified analysis according to body mass index (BMI ≥ 30 vs. <30 kg/m²). Methods: This analysis enrolled consecutive individuals with severe aortic stenosis (AS) who were treated with TAVR using either balloon-expandable or self-expanding valves. The primary outcome was the occurrence of stroke during the periprocedural period in the overall population and according to BMI (<30 vs. ≥30 kg/m²). Secondary endpoints included periprocedural parameters, clinical outcomes (in-hospital and 1-year mortality), and safety outcomes. Subgroup analysis was performed to assess stroke risk according to ACT values. Patients with atrial fibrillation or receiving chronic oral anticoagulation were excluded. Results: A total of 1045 patients underwent TAVR between 2022 and 2024, including 827 with BMI < 30 and 218 with BMI ≥ 30. The study population had a mean age of 82 ± 6 years, and 56% of patients were male. In the overall study population, the mean heparin dose was 47 U/kg and the mean ACT value was 218 s. Patients with lower BMI received higher heparin doses (50 vs. 40 U/kg, p < 0.01) and had higher ACT values (221 vs. 208 s, p < 0.01). Protamine use was low and similar between groups. Periprocedural stroke rates were low overall (1.1%) and comparable between study groups (1.2% vs. 0.9%, p = 0.71). One-year mortality was also similar (3% vs. 4%, p = 0.53), with no significant differences in other safety outcomes. Subgroup analysis by ACT (≤250 vs. >250 s) showed no difference in stroke rates (1% vs. 1.5%, p = 0.60). Conclusions: In this single-center cohort, differences in heparin dosing and ACT values were not associated with differences in peri-procedural stroke or overall procedural outcomes. However, given the low number of stroke events, these findings should be interpreted cautiously. Prospective randomized studies are needed to define optimal anticoagulation strategies during TAVR. Full article

(This article belongs to the Special Issue Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease: 2nd Edition)

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