Antiplatelet therapy following conservatively managed spontaneous coronary artery dissection

Madeline K Mahowald; Luis Ortega-Paz; Claudio Laudani; Dominick J Angiolillo

doi:10.1007/s11239-025-03114-1

Antiplatelet therapy following conservatively managed spontaneous coronary artery dissection

J Thromb Thrombolysis. 2025 May 26. doi: 10.1007/s11239-025-03114-1. Online ahead of print.

Authors

Madeline K Mahowald¹, Luis Ortega-Paz², Claudio Laudani^{2

3}, Dominick J Angiolillo²

Affiliations

¹ Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA. madeline.mahowald@jax.ufl.edu.
² Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA.
³ Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy.

PMID: 40415141
DOI: 10.1007/s11239-025-03114-1

Abstract

Spontaneous coronary artery dissection (SCAD) is a relatively uncommon but increasingly recognized etiology of acute coronary syndrome (ACS). Conservative management is generally recommended, but optimal medical therapy is unknown. The majority of patients are discharged on dual antiplatelet therapy consisting of aspirin and a P2Y12 inhibitor based on trials and guidelines developed for ACS caused by plaque rupture and subsequent platelet activation and aggregation. Observational trials have shown conflicting results on the effects of antiplatelet therapy on major adverse cardiac events after SCAD. This manuscript provides a review of the available data, including a meta- analysis, and offers recommendations for antiplatelet therapy after conservatively managed SCAD in clinical practice.

Keywords: Acute coronary syndrome; Antiplatelet therapy; Spontaneous coronary artery dissection.

Publication types

Review