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Antiplatelet therapy in cardiovascular disease: current status and future directions

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)2686-2699
Number of pages14
JournalBritish Journal of Clinical Pharmacology
Volume88
Issue number6
Early online date3 Feb 2022
DOIs
Accepted/In press22 Nov 2021
E-pub ahead of print3 Feb 2022
PublishedJun 2022

Bibliographical note

Funding Information: This work was supported by a King's British Heart Foundation Centre for Excellence Award [RE/18/2/34213]. Publisher Copyright: © 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

King's Authors

Abstract

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 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. [Abstract copyright: This article is protected by copyright. All rights reserved.]

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