Aspirin-free strategies in cardiovascular disease and cardioembolic stroke prevention.

Capodanno, Davide; Mehran, Roxana; Valgimigli, Marco; Baber, Usman; Windecker, Stephan; Vranckx, Pascal; Dangas, George; Rollini, Fabiana; Kimura, Takeshi; Collet, Jean-Philippe; Gibson, C Michael; Steg, Philippe Gabriel; Lopes, Renato D; Gwon, Hyeon-Cheol; Storey, Robert F; Franchi, Francesco; Bhatt, Deepak L; Serruys, Patrick W; Angiolillo, Dominick J (2018). Aspirin-free strategies in cardiovascular disease and cardioembolic stroke prevention. Nature reviews - cardiology, 15(8), pp. 480-496. Nature Publishing Group 10.1038/s41569-018-0049-1

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In patients with manifestations of cardiovascular disease, acetylsalicylic acid (popularly known as aspirin) has been the mainstay of treatment for decades owing to its capacity to reduce the risk of ischaemic events. Accordingly, novel antithrombotic therapies have been traditionally tested on a background of acetylsalicylic acid therapy. Although the adjunctive use of such antithrombotic therapies can potentially further reduce the risk of ischaemic events, these agents are also inevitably associated with an increased risk of bleeding. However, acetylsalicylic acid also increases the risk of bleeding, challenging the paradigm that this agent should remain the cornerstone of antiplatelet treatment when alternative antithrombotic agents are also used. Many antithrombotic compounds are characterized by increased potency and consistent efficacy, which might lessen the need for concomitant acetylsalicylic acid. Accordingly, numerous investigations are testing the hypothesis that acetylsalicylic acid-sparing regimens based on newer antithrombotic agents might have an increased net benefit for individual patients owing to the reduction in bleeding risk, without a trade-off in efficacy. This Review summarizes the state of the art relating to antithrombotic approaches with and without acetylsalicylic acid for the prevention of cardiovascular disease and cardioembolic stroke. Discussion of the scientific rationale, from bench to bedside, for ongoing studies of acetylsalicylic acid-free pharmacological strategies is included.

Item Type:	Journal Article (Review Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Valgimigli, Marco, Windecker, Stephan
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1759-5010
Publisher:	Nature Publishing Group
Language:	English
Submitter:	Nadia Biscozzo
Date Deposited:	07 Mar 2019 09:15
Last Modified:	05 Dec 2022 15:26
Publisher DOI:	10.1038/s41569-018-0049-1
PubMed ID:	29973709
URI:	https://boris.unibe.ch/id/eprint/125902