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Aspirin or P2Y12 inhibitor monotherapy in atherosclerotic cardiovascular disease?

Mattia Galli1,2, Jurrien Ten Berg3,4, Marco Valgimigli5,6

  • 1Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04100, Italy.

European Heart Journal
|November 10, 2025
PubMed

Insights

For patients with atherosclerotic disease, P2Y12 inhibitors may offer superior efficacy and safety over aspirin for long-term antiplatelet therapy, guiding optimal secondary prevention strategies.

Area of Science:

  • Cardiology
  • Pharmacology
  • Preventive Medicine

Background:

  • Antiplatelet therapy is crucial for managing atherosclerotic disease.
  • Aspirin has been the standard, but P2Y12 inhibitors are emerging as strong alternatives.

Purpose of the Study:

  • To compare the efficacy and safety of aspirin versus P2Y12 inhibitors.
  • To evaluate single antiplatelet strategies for secondary prevention in atherosclerotic disease.

Main Methods:

  • Review of current evidence comparing aspirin and P2Y12 inhibitors.
  • Analysis of cardiovascular events, safety, and practical considerations.

Main Results:

  • Emerging data suggest P2Y12 inhibitors may be preferred over aspirin.
  • Considerations include drug response variability, side effects, cost, and implementation.

Conclusions:

  • Clinicians should weigh the strengths and limitations of each agent.
  • Optimizing single antiplatelet selection is key for long-term secondary prevention.

Keywords:
AspirinCardiovascularClopidogrelP2Y12 inhibitorPrasugrelTicagrelor

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