Atherosclerotic cardiovascular disease (ASCVD) encompasses a spectrum of vascular conditions, including coronary artery disease (CAD) and lower extremity peripheral artery disease (PAD), which frequently coexist. In the setting of ASCVD, there is a common underlying pathophysiology for acute ischemic events related to platelet activation and thrombin generation. The scope of this review focuses on the role of dual-pathway inhibition, the approach combining antiplatelet and antithrombotic therapy, for improvement in cardiovascular outcomes in patients with ASCVD. To determine which patients with CAD and PAD may benefit from dual-pathway inhibition, a brief overview of clinical presentations for both stable CAD and the spectrum of lower extremity PAD is outlined.

1.
Eikelboom
JW
,
Connolly
SJ
,
Bosch
J
, et al
; COMPASS Investigators.
Rivaroxaban with or without aspirin in stable cardiovascular disease
.
N Engl J Med
.
2017
;
377
(
14
):
1319
-
1330
.
2.
Bonaca
MP
,
Bauersachs
RM
,
Anand
SS
, et al
.
Rivaroxaban in peripheral artery disease after revascularization
.
N Engl J Med
.
2020
May
21
;
382
(
21
):
1994
-
2004
.
3.
Gornik
HL
,
Aronow
HD
,
Goodney
PP
, et al
.
2024 ACC/AHA/AACVPR/ APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines
.
J Am Coll Cardiol
.
2024
;
83
(
24
):
2497
-
2604
.
4.
Virani
SS
,
Newby
LK
,
Arnold
SV
, et al
.
2023 AHA/ACC/ACCP/ASPC/ NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines
.
J Am Coll Cardiol
.
2023
;
82
(
9
):
833
-
955
.
5.
Grundy
SM
,
Stone
NJ
,
Bailey
AL
, et al
.
2018 AHA/ACC/AACVPR/AAPA/ ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines
.
J Am Coll Cardiol
.
2019
;
73
(
24
):
e285
-
e350
.
6.
CAPRIE Steering Committee
.
A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee
.
Lancet
.
1996
;
348
(
9038
):
1329
-
1339
.
7.
Ward
R
,
Long
C
,
Patel
MR
,
Jones
WS
.
Antithrombotic therapy in peripheral artery disease: a review of the EUCLID trial results and current ongoing trials
.
Clin Cardiol
.
2018
;
41
(
1
):
137
-
143
.
8.
Vandiver
JW
.
Selecting oral antithrombotic therapies in peripheral arterial disease: a guide for practitioners
.
Am J Health Syst Pharm
.
2025
;
18
:zxaf157.
9.
Bonaca
MP
,
Barnes
GD
,
Bauersachs
R
, et al
.
Antithrombotic strategies for patients with peripheral artery disease: JACC scientific statement
.
J Am Coll Cardiol
.
2024
;
84
(
10
):
936
-
952
.
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