Safety and tolerability of antiplatelet therapies for the secondary prevention of atherothrombotic disease.
Aggressive secondary prevention is critical to improving long-term outcomes in patients with ischemic coronary artery disease, cerebrovascular disease, and peripheral artery disease. An essential component of successful secondary prevention is antiplatelet therapy, which in most patient populations consists of aspirin, clopidogrel, aspirin plus clopidogrel, or aspirin plus extended-release dipyridamole. As is true for any pharmacologic agent, benefits must be balanced with risks. For antiplatelet agents, the most important risk is excess bleeding, especially as emerging evidence suggests that excess bleeding is associated with adverse long-term outcomes; thus prevention and management of excess bleeding is critically important. In addition, recommendations for avoidance and management of minor adverse events are described so that patients maintain drug adherence. Overall, aspirin, clopidogrel, aspirin plus clopidogrel, and aspirin plus extended-release dipyridamole have favorable risk-versus-benefit profiles when used as recommended in appropriate patient populations.
Spinler
Sarah A
SA
Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania 19104-4495, USA. s.spinle@usp.edu
D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D004176:Dipyridamole / Q000009:adverse effects / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D055502:Secondary Prevention / Q000379:methods*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin