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ROBERT L. TALBERT, PHARM.D, FCCP, BCPS, is a Professor, College of Pharmacy, University of Texas-Austin and Professor, School of Medicine, University of Texas Health Science Center at San Antonio Pharmacotherapy and Education Research Center MSC 6220, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 (talbert{at}uthscsa.edu).

Purpose. The role of antiplatelet therapy in preventing and treating cardiovascular disease is reviewed. Summary. Cardiovascular disease, especially coronary heart disease, contributes to substantial morbidity and mortality in the United States and raises healthcare costs. Current guidelines from the American College of Cardiology and the American Heart Association, in conjunction with the Society for Cardiovascular Angiography and Interventions, recommend percutaneous coronary intervention (PCI) and stent placement to improve cardiovascular outcomes in patients with acute coronary syndrome, which encompasses unstable angina and myocardial infarction. Following stent placement, dual antiplatelet therapy with aspirin and a thienopyridine (clopidogrel or ticlopidine) significantly reduces the incidence of early major adverse cardiac events and mortality compared with aspirin alone or in combination with warfarin, and is the current standard of care for patients undergoing PCI. Maintenance therapy should be continued for at least one month after placement of a bare-metal stent, and at least three months or six months after placement of a sirolimus- or paclitaxel-eluting stent; ideally, therapy should be continued for one year following PCI. Even utilizing this standard, however, adverse clinical events do occur. In addition, treatment is often discontinued within the first year after stent placement by either the healthcare provider or the patient. Conclusion. Premature discontinuation of antiplatelet therapy is associated with an increased risk of adverse outcomes and can be avoided through better understanding of these risks by healthcare professionals and improved patient education. Index terms: Aspirin; Cardiovascular diseases; Clopidogrel; Combined therapy; Mortality; Platelet aggregation inhibitors; Protocols; Stents; Ticlopidine

 

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