Background: Despite the developments of single or dual antiplatelet therapy consisting
of aspirin and/or clopidogrel, prasugrel or ticagrelor, post-acute coronary syndrome a room for potential
improvement towards optimal prevention persist. The addition of a direct oral anticoagulant
to the antiplatelet treatment of patients with the acute coronary syndrome is clinically practiced in
cases where anticoagulation is indicated by high thromboembolic risk.
Objective: The main objective of this review was to explore the role of supplementation with a direct
oral anticoagulant to antiplatelet (aspirin or P2Y12 inhibitor) in patients with the acute coronary
Methods: We have searched the Medline for studies involving direct oral anticoagulant use in acute
coronary syndrome. We have reviewed specific relevant 9 meta-analyses between the years 2012 to
Results: Our review of nine meta-analyses has revealed that the addition of direct oral anticoagulant
to antiplatelet therapy compared with antiplatelet alone was beneficial about the composite endpoints
of major ischemic events in patients with the acute coronary syndrome. Furthermore, the
combined regimen of single antiplatelet plus direct oral anticoagulant is as effective as the triple
regimen of dual antiplatelet plus direct oral anticoagulant and results in less bleeding.
Conclusion: Cardiologists should balance the efficacy with a higher risk of bleeding with more
intensified DOAC therapy. Better risk characterization and timely adaptation of the regime to the
patient's need should be tested. Recurrent ischemic events and bleeding event risk scoring should
guide individualized treatment.