[Contribution of platelet aggregation inhibitors in the prevention of complications of atherothrombosis].
RECOGNIZED EFFICACY: Platelet antiaggregats have been used with success for more than twenty years in industrialized countries, participating in reducing the number of complications of atherothrombosis. New compounds have appeared on the market over the last 3 years. CLOPIDOGREL: Clopidogrel is a thienopyridine similar to ticlopidine but with less toxicity, particularly hematological toxicity. Compared with aspirin for secondary prevention of atherothrombotic events in high risk patients, clopidogrel provides a significant 8.7% (p < 0.043) reduction in the relative risk of severe complications: myocardial infarction, ischemic stroke, death due to vascular cause. The most remarkable benefit is obtained in patients with atheromatous arteriopathy of the lower limbs: 23.8% reduction in relative risk. STENT AFTER ANGIOPLASTY: A combination regimen using aspirin and ticlopidine the month following stent implantation has allowed a very significant reduction in acute (within 24 hours) and subacute (within 30 days) coronary occlusions. Currently the aspirin-clopidogrel combination tends to be used instead of the aspirin-ticlopidine combination due to the lower hematological risk for a similar effect. GPIIBIIIA INHIBITORS: Injectable GPIIbIIIa inhibitors have changed management of the acute phase of coronary artery disease. Among these compounds, abciximab has the most extensively proven efficacy. It is mainly indicated for severe forms of coronary angioplasty with or without stent insertion. It provides a significant short-term and long-term reduction in severe events (myocardial infarction + death + revascularization). Oral formulations of GPIIbIIIa can be used to maintain and/or amplify the benefits obtained with injectable formulations. They are not currently available on the market.
Due to its very low cost and low side-effect profile, aspirin plays an essential role in most indications where it remains the most widely used first-line platelet anti aggregate.
Guilmot
J L
JL
Médecine interne B, CHU Bretonneau, Tours.
Diot
E
E
Gruel
Y
Y
D001241:Aspirin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D013927:Thrombosis / Q000150:complications* / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014652:Vascular Diseases / Q000209:etiology / Q000517:prevention & control*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin