Antiplatelet agents: Difference between revisions
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The most recent mechanistic addition is protease-activated-receptor-1 (PAR-1) inhibition. The thrombin receptor on the platelet surface, activated by thrombin's proteolytic cleavage of its N-terminus, drives a third independent pathway of platelet activation. [[wikipedia:Vorapaxar|Vorapaxar]] (Merck, 2014), the first PAR-1 antagonist, demonstrated a modest reduction in atherothrombotic events when added to aspirin and clopidogrel in patients with prior myocardial infarction or peripheral arterial disease (TRA 2°P-TIMI 50 trial); its clinical use has been limited by the bleeding-risk increment of triple antiplatelet therapy and by its contraindication in patients with prior stroke. | The most recent mechanistic addition is protease-activated-receptor-1 (PAR-1) inhibition. The thrombin receptor on the platelet surface, activated by thrombin's proteolytic cleavage of its N-terminus, drives a third independent pathway of platelet activation. [[wikipedia:Vorapaxar|Vorapaxar]] (Merck, 2014), the first PAR-1 antagonist, demonstrated a modest reduction in atherothrombotic events when added to aspirin and clopidogrel in patients with prior myocardial infarction or peripheral arterial disease (TRA 2°P-TIMI 50 trial); its clinical use has been limited by the bleeding-risk increment of triple antiplatelet therapy and by its contraindication in patients with prior stroke. | ||
The duration of dual or triple antiplatelet therapy is one of the most actively investigated clinical decisions in cardiovascular medicine. Modern second-generation | The duration of dual or triple antiplatelet therapy is one of the most actively investigated clinical decisions in cardiovascular medicine. Modern second-generation medicine-eluting stents allow DAPT durations as short as one month in selected lower-risk patients, balancing the residual stent-thrombosis risk against the cumulative bleeding cost of prolonged treatment. The CHARISMA, DAPT, PEGASUS, TWILIGHT, and HOST-EXAM trials have together defined a complex set of patient-specific algorithms for DAPT duration after acute coronary syndrome and after elective PCI; the contemporary trend has been toward shorter DAPT followed by either aspirin or P2Y12 monotherapy, with monotherapy with the more potent P2Y12 inhibitor (rather than the historical default of aspirin) increasingly favoured. | ||
== Classes indexed == | == Classes indexed == | ||