Antiplatelet therapy

Antiplatelet agents are an obligatory component of the treatment of all patients with ischemic heart disease and atherosclerotic vascular destruction of other localization, which have no contraindications. Considering the introduction of modern principles, rational antiplatelet therapy is an important factor in improving the course of atherothrombotic diseases, reducing disability and mortality.

Platelet glycoprotein receptor (GP) blockers have recently shown themselves to be good in the treatment of vascular events. After intravenous use of GP blockers (tirofiban, abciximab, eptifibatid), platelet aggregation is inhibited by 90% within two hours, but their function is restored within the next two days.

The most common side effect of drugs from this group is hemorrhages, so the simultaneous use of oral anticoagulants together with GP blockers is contraindicated. First of all, intravenous GP receptor blockers are used prophylactically in endovascular interventions. On the other hand, clinical studies with oral administration of various drugs from this group in patients with acute coronary syndromes (ACS) ended unsuccessfully, since the survival prognosis of patients did not improve, but even slightly worsened.

Today there is a need to introduce new therapeutic standards. Therefore, the effectiveness of various antiplatelet agents, both separately and in combination, is being studied. Among existing antiplatelet agents, more evidence of the ability to reduce the likelihood of new atherothrombotic complications was obtained for aspirin, thienopyridines (ticlopidine and clopidogrel), GP blockers, and dipyridamole. It is noted that the effect of intravenous GP receptor blockers has been proven only in patients with ACS when angioplasty is performed, and the advantages of dipyridamole are for the secondary prevention of ischemic cerebral circulation destruction.

Reviews of actual clinical practice and European registries show that the frequency of use of antiplatelet drugs falls far short of the existing therapeutic standards. For example, some drugs are routinely prescribed to fewer than half of MI patients with angina and peripheral arterial disease. The frequency of the use of antiplatelet agents is especially low in elderly and senile patients. Here you can find out stenting cost in moscow.

Antiplatelet therapy is used by only 25% of patients with diabetes mellitus and verified coronary artery disease, only 7% - without pronounced clinical manifestations of coronary artery disease, and less than 50% of patients with atrial fibrillation who do not take anticoagulants. The problem of insufficient use of aspirin and thienopyridines in the category of patients in whom the degree of risk and, accordingly, the expected benefit of treatment are the highest, is obvious.