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Antiplatelet Therapy for Secondary Prevention of Vascular Disease Complications

  • Nonstatin Drugs (E. deGoma, Section Editor)
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Abstract

Purpose of Review

Platelets are activated upon interaction with injured vascular endothelium to form a primary hemostatic plug. Pathogenic thrombosis driven by platelet aggregation can occur in the setting of vascular disease leading to ischemic events. The use of antiplatelet agents has become a mainstay for prevention of the secondary complications of vascular disease. This review summarizes seminal and recent literature related to this area.

Recent Findings

Aspirin is a cornerstone of antiplatelet therapy for coronary artery disease and cerebrovascular disease for prevention of myocardial infarction, stroke, and vascular death. Alternative antiplatelet agents have shown promise for use in patients with peripheral artery disease though further validation is necessary. Dual antiplatelet therapy (DAPT) with clopidogrel, prasugrel, or ticagrelor, and aspirin demonstrates benefit in patients with higher thrombotic risk. However, use of DAPT predictably increases bleeding risk, thus limiting mortality benefit. Individualization of DAPT to patient-specific features is an area of active research with the development the DAPT score and pharmacogenomic approaches. Application of pharmacogenetic data could allow for a precision medicine approach to tailoring antiplatelet therapy.

Summary

Recommendations for management of cardiovascular, cerebrovascular, and peripheral artery disease are largely based on large-scale randomized control trials and meta-analyses. Seminal trials have largely focused on prevention of vascular events including non-fatal MI, stroke, and vascular death in subsets of patients with cardiovascular disease. Data from these trials along with smaller studies have driven recommendations for secondary prevention management in patients with cerebrovascular and peripheral artery disease.

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Authors and Affiliations

  1. Hospital of University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA

    Rahul R. Goli, Mayur M. Contractor & Ashwin Nathan

  2. Smilow Center for Translational Research, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Sony Tuteja

  3. Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman Center South Tower, 11th Floor 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Taisei Kobayashi & Jay Giri

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  1. Rahul R. Goli
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Correspondence to Jay Giri.

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Rahul R. Goli, Mayur M. Contractor, Ashwin Nathan, and Taisei Kobayashi declare no conflict of interest.

Sony Tuteja reports grants from SpartanRx, Inc. outside the submitted work. Jay S. Giri reports grants from SpartanRx, Inc. outside the submitted work.

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Goli, R.R., Contractor, M.M., Nathan, A. et al. Antiplatelet Therapy for Secondary Prevention of Vascular Disease Complications. Curr Atheroscler Rep 19, 56 (2017). https://doi.org/10.1007/s11883-017-0698-2

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