Secondary prevention of acute coronary syndromes
Janet H Dailey1, Mark J Cziraky, Sarah A Spinler
1College of Pharmacy, University of Florida, Gainesville, USA.
Insights
Long-term antithrombotic therapy is crucial for preventing recurrent acute coronary syndromes (ACS). Combining agents like aspirin and clopidogrel offers synergistic benefits for secondary prevention after hospital discharge.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Acute coronary syndromes (ACS) carry a high risk of recurrence.
- A persistent prothrombotic state following ACS necessitates ongoing preventive strategies.
Purpose of the Study:
- To review the role of antithrombotic therapy in preventing ACS recurrence after hospital discharge.
Main Methods:
- Systematic review of recent (1995-2003) English-language scientific literature.
- Inclusion of randomized controlled trials and review articles identified via Medline search.
Main Results:
- Aspirin and clopidogrel demonstrate synergistic antiplatelet effects, with combination therapy recommended for ACS patients.
- Long-term dual antiplatelet therapy is advised due to persistent thrombus formation stimulus.
- Aspirin and warfarin combination shows potential but faces challenges in balancing bleeding risk and efficacy.
Conclusions:
- The sustained prothrombotic stimulus post-ACS justifies long-term antithrombotic therapy.
- Optimizing antithrombotic regimens is key for secondary prevention of ischemic events.
Objective:
To review the role of antithrombotic therapy for prevention of acute coronary syndrome (ACS) recurrence following hospital discharge.
Data Sources:
Recent (1995-2003) published scientific literature, as identified by the authors through Medline searches, using the terms acute coronary syndromes, antithrombotic, antiplatelet, clinical trials, and reviews on treatment.
Study Selection:
Recent systematic English-language review articles and reports of controlled randomized clinical trials were screened for inclusion.
Data Synthesis:
Despite aspirin prophylaxis, the biochemical stimulus for thrombus formation persists for several months after an acute coronary event. Ideally, multiple antithrombotic agents with complementary mechanisms of action should be used for secondary prevention of ischemic events after hospital discharge. Aspirin and clopidogrel (Plavix-Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership) have synergistic antiplatelet effects, and long-term combination therapy with these agents is currently recommended for patients with ACS. The combination of aspirin and warfarin offers potential advantages as an antithrombotic regimen for secondary prevention of ACS (i.e., suppression of the coagulation cascade and platelet function); however, the optimal balance between bleeding risk and antithrombotic benefit is difficult to achieve in practice.
Conclusion:
Persistence of the prothrombotic stimulus after an acute coronary event provides a clear rationale for long-term antithrombotic therapy to prevent the recurrence of ischemic events.
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