Dual Antiplatelet Therapy for Prevention of Recurrent Ischemic Events

Jean Nappi, PharmD, Fccp, Bcps; Robert Talbert, PharmD, Fccp, Bcps

Disclosures

Am J Health Syst Pharm. 2002;59(18) 

In This Article

Summary

Prevention of secondary vascular events in patients with established atherosclerosis is crucial to reducing morbidity and mortality. Antiplatelet monotherapy with aspirin, clopidogrel, or ticlopidine is currently recommended for preventing stroke and MI in patients at a high risk of recurrent ischemic vascular events. Aspirin has been the standard therapy, but results from the CAPRIE trial found that clopidogrel was slightly more effective than aspirin in reducing ischemic events.[60,61]

The potential effectiveness of dual oral antiplatelet therapy in the prevention of ischemic vascular events is currently under investigation. The rationale for using a combination of two mechanistically different anti-platelet agents is supported by ex vivo and clinical studies. Inhibition of platelet aggregation and thrombus formation is enhanced with dual antiplatelet therapy.

The combination of an ADP antagonist with aspirin is particularly effective. Clopidogrel has demonstrated enhanced efficacy when used in combination with aspirin for the reduction of ischemic events in patients with atherosclerotic disease with acceptable levels of adverse events. Ticlopidine has also showed increased efficacy in combination with aspirin, but it is associated with serious hematologic events. Ongoing trials should provide important information on the utility of combination agents in a variety of clinical settings.

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