Tag Archives: Antiplatelet

Introduction Peripheral artery disease (PAD) refers to all arterial disease outside of the coronary arteries and the aorta.1 It is estimated that over 200 million individuals are living with PAD globally.2,3 In the Western world, one in five adults over the age of 75 has PAD, including over 40 million Europeans.3-6 Though the prevalence of PAD is already at endemic levels worldwide, ageing populations and the increasing burden of chronic disease (i.e. hypertension, dyslipidaemia, diabetes mellitus, smoking) will contribute to further increases in the incidence and prevalence of PAD in the coming decades.2,3 As a consequence, PAD is the third

Background The novel oral anticoagulant (NOAC) agents (dabigatran, rivaroxaban, apixaban) have had a disproportionally poor uptake since their respective launches and National Institute for Health and Care Excellence (NICE) Technology Appraisal in the UK between 2012 and 2013 for their use in stroke prevention in patients with non-valvular atrial fibrillation (NVAF), when compared with our European counterparts; particularly Germany, Holland and France. In the original NICE economic analyses for the NOACs there was a calculated uptake of approximately 20% in the first year,1 the figure currently runs at <8% with many area’s significantly

Mechanisms Figure 1. Platelet-fibrin thrombus in a coronary artery of a patient with acute coronary syndrome The mechanism of action of aspirin differs from that of other antiplatelet agents. Aspirin irreversibly acetylates platelet cyclooxygenase-1 (COX-1), completely inhibiting COX-1- dependent synthesis of thromboxane A2 (TXA2), a substance which is a potent vasoconstrictor and promoter of platelet aggregation. Whether low-dose aspirin also exerts a significant anti-inflammatory effect is uncertain: a retrospective sub-analysis suggested that it was more effective in primary prevention in individuals who had high levels of C-reacti

Dual antiplatelet therapy for all CVD patients? Table 1. Currently used antiplatelet drugs Currently used antiplatelet drugs are summarised in table 1 and pivotal clinical trials of dual antiplatelet therapy in table 2. The Clopidogrel for High Atherothrombotic Risk and Ischaemia Stabilisation, Management and Avoidance (CHARISMA) trial2 is the only prospective randomised clinical trial to evaluate the efficacy and safety of dual antiplatelet therapy in all CVD patients. Initiated after the Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE) trial had shown a 9% relative risk reduction with clopidogrel compared w

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