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[Platelets, atherothrombosis, antiplatelet drugs and cerebral ischemia]

Marie-Germaine Bousser

    Bulletin De L'Academie Nationale De Medecine
    |June 13, 2014
    PubMed

    Insights

    Aspirin is the preferred antiplatelet drug for preventing heart attacks and strokes due to its effectiveness and safety. While other drugs exist for secondary stroke prevention, aspirin remains the global standard for its favorable cost, benefit, and tolerability profile.

    Area of Science:

    • Cardiology
    • Neurology
    • Pharmacology

    Context:

    • Platelet aggregation is a key factor in ischemic events, particularly myocardial infarction.
    • Atherothrombosis underlies most heart attacks but only a minority of strokes.
    • Treatment strategies for acute myocardial and cerebral ischemia differ significantly.

    Purpose:

    • To compare the role of platelets and the efficacy of antiplatelet drugs in myocardial versus cerebral ischemia.
    • To evaluate antiplatelet therapies for primary and secondary prevention of ischemic events.
    • To analyze revascularization and antiplatelet strategies in acute ischemic conditions.

    Summary:

    • Aspirin is the sole effective agent for primary prevention of ischemic events, especially cardiac ones.
    • For secondary stroke prevention, aspirin alone is the gold standard due to its cost-benefit profile, despite marginal improvements with clopidogrel or aspirin/dipyridamole combinations.
    • The combination of clopidogrel and aspirin is discouraged due to hemorrhage risks. Acute treatment differs: aggressive platelet inhibition for heart attacks versus thrombolysis/aspirin for strokes.

    Impact:

    • Highlights aspirin's continued importance in cardiovascular and cerebrovascular event prevention.
    • Underscores the distinct pathophysiological roles of platelets in heart attacks versus strokes.
    • Identifies gaps in research regarding novel antiplatelet agents for acute cerebral ischemia.

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