Advances in antiplatelet therapies for patients with cardiovascular disease have improved patient outcomes over time, but the challenge of balancing the risks of ischaemia and bleeding remains substantial. Moreover, many patients with cardiovascular disease have a residual risk of ischaemic events despite receiving antiplatelet therapy. Therefore, novel strategies are needed to prevent clinical events through mechanisms beyond platelet inhibition and with an acceptable associated risk of bleeding. The advent of non-vitamin K antagonist oral anticoagulants, which attenuate fibrin formation by selective inhibition of factor Xa or thrombin, has renewed the interest in dual-pathway inhibition strategies that combine an antiplatelet agent with an anticoagulant drug. In this Review, we highlight the emerging pharmacological rationale and clinical development of dual-pathway inhibition strategies for the prevention of atherothrombotic events in patients with different manifestations of cardiovascular disease, such as coronary artery disease, cerebrovascular disease and peripheral artery disease.

中文翻译：

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双重途径抑制可预防心血管疾病的二级和三级抗血栓形成。

随着时间的流逝，针对心血管疾病患者的抗血小板治疗的进步已改善了患者的预后，但平衡缺血和出血风险的挑战依然巨大。此外，尽管接受抗血小板治疗，许多心血管疾病患者仍有局部缺血事件的风险。因此，需要新的策略来通过血小板抑制以外的机制以及具有可接受的相关出血风险来预防临床事件。通过选择性抑制因子Xa或凝血酶来减弱纤维蛋白形成的非维生素K拮抗剂口服抗凝剂的出现，引起了人们对结合抗血小板药和抗凝药的双重途径抑制策略的兴趣。在这篇评论中，