Republished: Antiplatelet therapy for secondary prevention of coronary artery disease

Pilgrim, Thomas; Windecker, Stephan (2015). Republished: Antiplatelet therapy for secondary prevention of coronary artery disease. Postgraduate medical journal, 91(1075), pp. 284-290. BMJ Publishing Group 10.1136/postgradmedj-2013-305399rep

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The choice and duration of antiplatelet therapy for secondary prevention of coronary artery disease (CAD) is determined by the clinical context and treatment strategy. Oral antiplatelet agents for secondary prevention include the cyclo-oxygenase-1 inhibitor aspirin, and the ADP dependent P2Y12 inhibitors clopidogrel, prasugrel and ticagrelor. Aspirin constitutes the cornerstone in secondary prevention of CAD and is complemented by clopidogrel in patients with stable CAD undergoing percutaneous coronary intervention. Among patients with acute coronary syndrome, prasugrel and ticagrelor improve net clinical outcome by reducing ischaemic adverse events at the expense of an increased risk of bleeding as compared with clopidogrel. Prasugrel appears particularly effective among patients with ST elevation myocardial infarction to reduce the risk of stent thrombosis compared with clopidogrel, and offered a greater net clinical benefit among patients with diabetes compared with patients without diabetes. Ticagrelor is associated with reduced mortality without increasing the rate of coronary artery bypass graft (CABG)-related bleeding as compared with clopidogrel. Dual antiplatelet therapy should be continued for a minimum of 1 year among patients with acute coronary syndrome irrespective of stent type; among patients with stable CAD treated with new generation drug-eluting stents, available data suggest no benefit to prolong antiplatelet treatment beyond 6 months.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Pilgrim, Thomas and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0032-5473

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Judith Liniger

Date Deposited:

01 Mar 2016 15:26

Last Modified:

01 Mar 2016 15:26

Publisher DOI:

10.1136/postgradmedj-2013-305399rep

PubMed ID:

25976494

Uncontrolled Keywords:

Coronary Artery Disease

BORIS DOI:

10.7892/boris.75927

URI:

https://boris.unibe.ch/id/eprint/75927

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