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Future perspectives for optimizing oral antiplatelet therapy.

¹Department of Neurology, Brown University, Providence, RI 02903, USA. j_easton@brown.edu

Cerebrovascular Diseases (Basel, Switzerland)

|April 24, 2001

Summary

Combining antiplatelet therapies like clopidogrel and aspirin shows promise for preventing recurrent atherothrombotic events. Further research is exploring optimal combinations for secondary stroke prevention.

Area of Science:

Cardiology
Neurology
Pharmacology

Background:

Secondary prevention of atherothrombosis is crucial for reducing disease burden.
Identifying patients who benefit most from antiplatelet therapy is essential.
Combining antiplatelet agents with different mechanisms enhances efficacy by targeting diverse platelet activation pathways.

Purpose of the Study:

To evaluate the efficacy of combined antiplatelet therapy in secondary prevention of atherothrombotic events.
To explore novel antiplatelet combinations for stroke and myocardial infarction prevention.
To assess the safety and effectiveness of clopidogrel plus aspirin versus other regimens.

Main Methods:

Ongoing and planned clinical trials investigating antiplatelet combinations, including clopidogrel plus aspirin.

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Comparison of clopidogrel with placebo in aspirin-treated patients (e.g., CURE, COMMIT).

Evaluation of clopidogrel plus aspirin versus clopidogrel monotherapy in high-risk patients (e.g., MATCH).

Main Results:

Combination therapy with adenosine diphosphate receptor antagonists and aspirin shows promise.
Oral glycoprotein IIb/IIIa receptor antagonist plus aspirin trials have yielded less favorable results, with some showing increased mortality.
Dipyridamole plus aspirin appears superior to aspirin alone for stroke prevention, with ongoing investigation (ESPRIT).

Conclusions:

Combination antiplatelet therapy, particularly clopidogrel plus aspirin, holds significant potential for secondary prevention of atherothrombosis.
Further research is needed to optimize combination strategies and confirm benefits in specific patient populations.
The combination of dipyridamole plus aspirin warrants further investigation for stroke prevention.