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Antiplatelet treatments: recent evidence from randomized controlled trials
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Current Opinion in Cardiology
|May 3, 2017
Summary
Recent studies show ticagrelor plus aspirin reduces ischemic events but increases bleeding in coronary artery disease patients. Ticagrelor monotherapy offers no ischemic benefit in stroke or peripheral vascular disease. Platelet function monitoring is not recommended.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Medicine
Background:
- Atherosclerosis management relies on antiplatelet therapies.
- Evaluating newer antiplatelet agents is crucial for optimizing patient outcomes.
Purpose of the Study:
- To review recent randomized trials on antiplatelet therapies for atherosclerosis.
- To assess the efficacy and safety of ticagrelor and other agents.
Main Methods:
- Systematic review of randomized controlled trials published within the last two years.
- Analysis of pharmacokinetic/pharmacodynamic studies on P2Y12 inhibitors.
Main Results:
- Ticagrelor plus aspirin reduced ischemic events but increased bleeding in stable coronary artery disease with myocardial infarction history.
- Ticagrelor monotherapy showed no ischemic benefit in stroke or peripheral vascular disease.
- Newer P2Y12 inhibitors (prasugrel, ticagrelor) provide faster, stronger platelet inhibition than clopidogrel; switching between them is safe.
Conclusions:
- Antiplatelet strategies, including ticagrelor, have varied clinical effects across patient groups.
- Newer P2Y12 inhibitors offer enhanced platelet inhibition, and switching regimens is feasible.
- Routine platelet function monitoring is not prognostically valuable for guiding therapy.
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