Role of Antiplatelet Therapy in Secondary Prevention of Acute Coronary Syndrome

2011 ◽  
Vol 5 (1) ◽  
pp. 41-51 ◽  
Author(s):  
Mathieu Pankert ◽  
Jacques Quilici ◽  
Thomas Cuisset
Keyword(s):  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Coronary Syndrome

scholarly journals Old and New Players in Oral Antiplatelet Therapy in Treatment of Acute Coronary Syndrome

1970 ◽  
Vol 1 (1) ◽  
pp. 49-55
Author(s):  
SC Kohli
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Antiplatelet Drugs ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Oral antiplatelet therapy plays an important role in treating patients with acute coronary syndrome (ACS), including patients with unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI) and patients with ST-segment elevation myocardial infarction (STEMI). All antiplatelet drugs in addition to inhibiting acute arterial thrombosis have danger of interfering with the physiologic role of platelet hemostasis. Bleeding is a major factor in evaluating the utility of available and upcoming antiplatelet drugs and their combination regimes. The role of anti platelet agents in the treatment of ACS has undergone significant changes over the past several years. Aspirin, thienopyridines, and glycoprotein (GP) IIb/IIIa inhibitors are now standard parts of the treatment of STEMI, NSTEMI and UA whether an early invasive or an initial conservative strategy is chosen. Antiplatelet drugs have an important role in secondary prevention in the patients of ischaemic heart disease. Keywords: Acute Coronary Syndrome; antiplatelet therapy; thienopyridines. DOI: http://dx.doi.org/10.3126/njms.v1i1.5799   Nepal Journal of Medical Sciences. 2012; 1(1): 49-55

scholarly journals PCV68 COST-EFFECTIVENESS OF GENOTYPE-DRIVEN ANTIPLATELET THERAPY FOR SECONDARY PREVENTION AFTER ACUTE CORONARY SYNDROME

2010 ◽  
Vol 13 (3) ◽  
pp. A162
Author(s):  
DJ Crespin ◽  
JJ Federspiel ◽  
AK Biddle ◽  
D Jonas ◽  
SC Stearns ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cost Effectiveness ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Coronary Syndrome

New Antiplatelet Drugs in Perspective

2011 ◽  
Vol 7 (3) ◽  
pp. 216
Author(s):  
Diego Penela ◽  
Maríbel Diaz-Ricart ◽  
Magda Heras ◽  
◽  
◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Acute Phase ◽  
Platelet Inhibition ◽  
Antiplatelet Drugs ◽  
Coronary Syndrome ◽  
Urgent Surgery

Treatment with antiplatelet therapy is mandatory in acute coronary syndrome. The effectiveness of aspirin and clopidogrel both in the acute phase and in secondary prevention has been clearly demonstrated, although some problems have also arisen, such as variability of platelet inhibition with clopidogrel or increased bleeding in patients undergoing urgent surgery. New antiplatelet drugs have been tested and are currently incorporated into the therapeutic armamentarium. Their different pharmacokinetic and pharmacodynamic properties are a good addition to the classic antiplatelet therapy, overcoming some of its limitations. In this context, the choice of appropriate antiplatelet therapy requires an individualised approach. The aim of this article is to summarise existing evidence and highlight the main features of the new antiplatelet drugs, as well as offering a vision of some challenges in the use of this therapy.

scholarly journals The Role of Clopidogrel in 2020: A Reappraisal

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
Giuseppe Patti ◽  
Giuseppe Micieli ◽  
Claudio Cimminiello ◽  
Leonardo Bolognese
Keyword(s):  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Minor Stroke ◽  
Clinical Settings ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Integral Role ◽  
Artery Disease ◽  
Ischemic Attack

Antiplatelet therapy is the mainstay of treatment and secondary prevention of cardiovascular disease (CVD), including acute coronary syndrome (ACS), transient ischemic attack (TIA) or minor stroke, and peripheral artery disease (PAD). The P2Y12 inhibitors, of which clopidogrel was the first, play an integral role in antiplatelet therapy and therefore in the treatment and secondary prevention of CVD. This review discusses the available evidence concerning antiplatelet therapy in patients with CVD, with a focus on the role of clopidogrel. In combination with aspirin, clopidogrel is often used as part of dual antiplatelet therapy (DAPT) for the secondary prevention of ACS. Although newer, more potent P2Y12 inhibitors (prasugrel and ticagrelor) show a greater reduction in ischemic risk compared with clopidogrel in randomized trials of ACS patients, these newer P2Y12 inhibitors are often associated with an increased risk of bleeding. Deescalation of DAPT by switching from prasugrel or ticagrelor to clopidogrel may be required in some patients with ACS. Furthermore, real-world studies of ACS patients have not confirmed the benefits of the newer P2Y12 inhibitors over clopidogrel. In patients with very high-risk TIA or stroke, short-term DAPT with clopidogrel plus aspirin for 21–28 days, followed by clopidogrel monotherapy for up to 90 days, is recommended. Clopidogrel monotherapy may also be used in patients with symptomatic PAD. In conclusion, there is strong evidence supporting the use of clopidogrel antiplatelet therapy in several clinical settings, which emphasizes the importance of this medication in clinical practice.

The role of Direct Oral Anticoagulant in patients with Acute Coronary Syndrome on single or dual antiplatelet regime: review of opportunities and challenges

2020 ◽  
Vol 15 ◽  
Author(s):  
Asim Ahmed Elnour ◽  
András Komócsi ◽  
Péter Kupó ◽  
Israa Yousif El Khidir ◽  
Seeba Zachariah ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Oral Anticoagulant ◽  
Bleeding Event ◽  
Direct Oral Anticoagulant ◽  
Coronary Syndrome ◽  
Potential Improvement ◽  
Triple Regimen ◽  
Meta Analyses

Background: Despite the developments of single or dual antiplatelet therapy consisting of aspirin and/or clopidogrel, pra - sugrel or ticagrelor, post-acute coronary syndrome a room for potential improvement toward optimal prevention persist. Addition of a direct oral anticoagulant to the antiplatelet treatment of patients with acute coronary syndrome is clinically practiced in cases where anticoagulation is indicated by high thromboembolic risk. Objective: The main objectives of this review, was to explore the role of supplementation with a direct oral anticoagulant to an - tiplatelet (aspirin or P2Y12 inhibitor) in patients with acute coronary syndrome. 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 2019. Results: Our review of nine meta-analyses has revealed that addition of direct oral anticoagulant to antiplatelet therapy compared with antiplatelet alone was beneficial about the composite end-points of major ischemic events in patients with acute coronary syndrome. Furthermore the combined regimen of single antiplatelet plus direct oral anticoagulant is as effective as the triple regimen of dual an - tiplatelet plus direct oral anticoagulant and results in less bleeding. Conclusion: Cardiologists should balance the efficacy with higher risk of bleeding with more intensified DOAC therapy. Better risk characterization and timely adaptation of the regime to the patients need should be tested. Recurrent ischemic event and bleeding event risk scoring should guide individualized treatment.

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