Platelet Inhibition in Cardiovascular Disease Management: Aspirin and Beyond.
Intracoronary thrombosis is the central event in the pathophysiology of the acute coronary syndromes and of the complications of percutaneous coronary intervention. Hemostasis and thrombosis involve a complex series of interactions of both platelets and the coagulation system. Standard antithrombotic therapy for cardiovascular disease typically combines use of antiplatelet therapy with aspirin and antithrombin therapy with heparin. Ticlopidine appears to be a reasonable alternative as an antiplatelet agent in the patient who is intolerant of aspirin. The combination of ticlopidine and aspirin may be especially effective in preventing coronary events in the post-coronary stenting patient. Clopidogrel may offer incremental benefit beyond aspirin in a broad array of vascular diseases, but the cost effectiveness of such a strategy remains to be determined. Finally, potent antiplatelet therapy with platelet glycoprotein IIb/IIIa receptor inhibition clearly improves angioplasty outcomes and may have a role in the treatment of patients with acute coronary syndromes.
Harrington
RA
Duke Clinical Research Institute, Durham, North Carolina.