Chronic stable angina has now been replaced by chronic coronary syndrome (CCS). The selection of antithrombotics in CCS is most important to prevent recurrence of ischemic events. The high-risk groups include the elderly and patients with peripheral arterial disease (PAD), chronic kidney disease (CKD), previous history of myocardial infarction (MI), stroke, atrial fibrillation and bleeding disorders.Identifying subsets who require longer duration of dual antiplatelet therapy (DAPT) vs single antiplatelet therapy (SAPT) or combination of antiplatelets and anticoagulants is a must. Longer duration of DAPT or combination of two different antithrombotics should be instituted.

A delicate balance exists between thrombotic risk vs. bleeding risk. In CCS, bleeding risk carries greater mortality than thrombotic risk. Therefore, overenthusiasm in using antithrombotics should be avoided. The use of antithrombotics in CCS requires a tailored approach. Scores such as DAPT, REPLACE DAPT, CHA2DS2-VASc can be used to tailor the therapy.