title: Antiplatelet and antithrombotic treatment after primary percutaneous coronary intervention: balancing safety and efficacy.
abstract: Antiplatelet therapy has been shown to significantly reduce the risk of serious vascular events in high-risk patients, including those with a prior acute ischemic event. The long-term use of antiplatelet agents is a key component of secondary prevention measures following acute coronary syndromes, including ST-segment elevation myocardial infarction. While minimizing ischemic recurrences, an intensified antiplatelet regimen also invariably leads to an increased risk for bleeding, which can in turn lead to treatment discontinuation and worse overall cardiovascular outcomes. Thus, a critical balance between efficacy and safety must be pursued in clinical practice. Selection of agents and their combination, dose optimization, and a customized approach based on genotype or assessment of on-treatment phenotype are discussed in the context of available evidence.
authors.affiliation: University of Ferrara, Italy and Cardiovascular Research Centre, Salvatore Maugeri Foundation, IRCCS Gussago (BS), Italy. vlgmrc@unife.it
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Monica
authors.initials: M
authors.lastname: Minarelli
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D000068799:Prasugrel Hydrochloride; D018570:Risk Assessment; D012449:Safety; D055502:Secondary Prevention; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D014859:Warfarin; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin