Rationale for antiplatelet therapy in patients with atherothrombotic disease.
The most common cause of morbidity and mortality in developed countries results from atherosclerosis and superimposed thrombosis (atherothrombosis) leading to partial or complete vascular occlusion. Much evidence supports the idea that all atherothrombosis is similar, regardless of which vascular bed it occurs in. Thus, similar therapies may be used for patients with symptomatic cardiac, cerebral, or peripheral vascular disease. The types of agents that have shown efficacy in atherothrombosis include antihypertensives, lipid-lowering agents and antiplatelet agents. The focus of this article is on the antiplatelet agents, of which there are several subcategories, including ADP receptor antagonists, GpIIb/IIIa antagonists, cyclo-oxygenase inhibitors and prostacyclin analogues. Clinical testing of these agents is ongoing and the efficacy and safety of the various agents are being defined. To date, the ADP receptor antagonist, clopidogrel, appears to provide the best antithrombotic result with the fewest side effects. Further testing may reveal that combinations of the various forms of antiplatelet agents may provide even further improvements on safety and efficacy.
Dormandy
J A
JA
St George's Hospital Medical School, St George's Hospital, London, UK.
D001161:Arteriosclerosis / Q000188:drug therapy* / Q000517:prevention & control; D000077144:Clopidogrel; D018849:Controlled Clinical Trials as Topic; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D011464:Epoprostenol / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D058919:Purinergic P2 Receptor Antagonists; D013927:Thrombosis / Q000188:drug therapy* / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D016861:Cyclooxygenase Inhibitors; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D058919:Purinergic P2 Receptor Antagonists; D000077144:Clopidogrel; D011464:Epoprostenol; D013988:Ticlopidine