Antiplatelet therapy plays a crucial role in a number of cardiovascular disorders. We currently have a range of antiplatelet agents in our armamentarium. In this review, we aim to summarise the common antiplatelet agents currently available, and their use in clinic practice. We not only highlight recent trials exploring antiplatelet therapy in atherosclerotic cardiovascular disease, but also in trials related to transcatheter aortic valve implantation and coronavirus disease 2019. Inevitably, the antithrombotic benefits of these drugs are accompanied by an increase in bleeding complications. Therefore, an individualised approach to weighing each patient’s thrombotic risk versus bleeding risk is imperative, in order to improve clinical outcomes.

Background: Left ventricular thrombus (LVT) remains a well-recognized complication following myocardial infarction (MI). Whilst vitamin K antagonists (VKAs) have traditionally been the cornerstone of management, direct oral anticoagulants (DOACs) have been increasingly utilized despite limited data to support this. We sought to perform an up-to-date meta-analysis of all randomized controlled trials (RCTs) comparing DOACs to VKAs for LVT resolution. Methods: A systematic search of major scientific databases was performed to identify RCTs published until May 2025. The primary efficacy endpoint was complete LVT resolution at 3 months. The risk ratio (RR) and 95% confidence intervals (CIs) of the individual RCTs were pooled via the inverse-variance method and random-effects model. Results: Seven RCTs involving 554 patients with a mean age of 54 years were included in the meta-analysis. At 3 months, there was no difference in the rate of LVT resolution between those in the DOAC arm and the warfarin arm (86% vs. 81%, RR 1.01 [95%CI 0.93–1.10], p = 0.76). There was low heterogeneity at I² = 15%. There was no difference in major or clinically significant bleeding or in the composite of stroke or thromboembolic complications, although the 95%CIs were wide. Conclusions: DOACs appear to be comparable to warfarin in achieving LVT resolution at 3 months. These findings support the consideration of DOACs as alternatives to VKAs in selected patients for LVT resolution. Further adequately powered trials and head-to-head comparisons between DOACs are required to confirm their safety.

Percutaneous coronary intervention (PCI) is a widely performed revascularisation procedure for coronary artery disease. Although effective, its reliance on fluoroscopy and iodinated contrast exposes patients and operators to risks of radiation and nephrotoxicity. As PCI techniques have become more complex, interest has grown in imaging methods that reduce dependence on fluoroscopy and contrast. Electro-anatomical mapping systems (EAMS), developed for catheter navigation in electrophysiology, enable real-time three-dimensional visualisation without the need for fluoroscopy or contrast. By adapting coronary guidewires as electrodes, EAMS can reconstruct vessel anatomy and track interventional tools in real time. EAMS have demonstrated feasibility and safety in device implantation, and early studies suggest their applicability to PCI, where they may mitigate radiation and contrast exposure by providing an alternative method for guidewire and stent visualisation. This review provides a narrative overview of current evidence, outlining the technical principles, applications in device implantation, and the emerging role of EAMS in coronary intervention.