Antiplatelet therapy in cardiovascular disease: Current status and future directions.
Gabriella PassacqualePankaj SharmaDivaka PereraAlbert FerroPublished in: British journal of clinical pharmacology (2022)
Antiplatelet medications remain a cornerstone of therapy for atherosclerotic cardiovascular and cerebrovascular diseases. In primary prevention (patients with cardiovascular risk factors but no documented events, symptoms or angiographic disease), there is little evidence of benefit of any antiplatelet therapy, and such therapy carries the risk of excess bleeding. Where there is documented disease (secondary prevention), stable patients benefit from long-term antiplatelet monotherapy, aspirin being first choice in those with coronary heart disease and clopidogrel in those with cerebrovascular disease; moreover, recent evidence shows that low-dose rivaroxaban in combination with aspirin confers added benefit, in patients with stable cardiovascular and peripheral arterial disease. In patients with acute cerebrovascular disease, aspirin combined with clopidogrel reduces subsequent risk, while in acute coronary syndrome, dual antiplatelet therapy comprising aspirin and a P2Y 12 inhibitor (clopidogrel, prasugrel or ticagrelor) confers greater protection than aspirin monotherapy, with prasugrel and ticagrelor offering greater antiplatelet efficacy with faster onset of action than clopidogrel. Although greater antiplatelet efficacy is advantageous in preventing thrombotic events, this must be tempered by increased risk of bleeding, which may be a particular issue in certain patient groups, as will be discussed. We will also discuss possible future approaches to personalisation of antiplatelet therapy.
Keyphrases
- antiplatelet therapy
- acute coronary syndrome
- percutaneous coronary intervention
- st segment elevation myocardial infarction
- low dose
- st elevation myocardial infarction
- cardiovascular risk factors
- cardiovascular disease
- coronary artery disease
- atrial fibrillation
- end stage renal disease
- newly diagnosed
- randomized controlled trial
- chronic kidney disease
- physical activity
- case report
- ejection fraction
- prognostic factors
- cardiovascular events
- combination therapy
- depressive symptoms
- pulmonary embolism
- patient reported outcomes