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

The Diffuse Nature of Atherothrombosis

Patients with any clinical manifestation of atherosclerosis are vulnerable to others in different vascular beds since the disease develops throughout the vasculature, and different vascular events have common predisposing risk factors.[7,20,21,22] A retrospective study of 1802 elderly patients, which was designed to investigate the prevalence of coexisting coronary artery disease, stroke, and peripheral arterial disease (PAD) alone or in combination, showed a high rate of atherosclerosis affecting multiple vascular territories.[20] Most frequently, coronary artery disease was found concomitantly in 68% of PAD patients and in 56% of stroke patients. A 30-year follow-up of 5209 patients in the Framingham Heart Study found that one atherosclerotic ischemic event was associated with a strong tendency to develop another.[7] Within 10 years of an ischemic stroke, 25% of women and 44% of men developed subsequent CHD. Similarly, 24% of women and 16% of men who had survived an MI later suffered a stroke or transient ischemic attack (TIA). Of those patients in whom PAD was diagnosed first, 40% of women and 22% of men subsequently developed CHD, and 20% of women and 22% of men experienced an ischemic stroke.[7] Hence, the rationale for oral antiplatelet therapy in these patients was based on the systemic nature of atherosclerosis, coexistent vascular disease, and the central role platelets serve in thrombus formation.

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