Impact of antiplatelet therapy in heart disease

Because platelet activation plays an important pathophysiological role in acute coronary syndromes, antiplatelet agents are a mainstay of cardiovascular therapy, both in high-risk primary prevention and in secondary prevention. This is usually done with aspirin in all such cases, and adding a P2Y(12) inhibitor in secondary prevention usually for 1 year after an acute coronary syndrome, especially after stent implantation. P2Y(12) inhibitors include ticlopidine (now rarely used), clopidogrel, prasugrel, and ticagrelor. In the setting of high-risk acute coronary syndromes treated with percutaneous coronary interventions, the addition of a glycoprotein IIb/IIIa antagonist, especially abciximab, is contemplated. Conversely, the role of antiplatelet therapy in preventing stroke after atrial fibrillation has been recently downgraded in most risk classes, in favor of anticoagulants. This chapter provides a general overview of the use of antiplatelet agents in heart disease.