Fahim H Jafary.
Beyond Aspirin – New Antiplatelet agents and their role in the management of vascular disease.
Pak J Med Sci Jan ;18(4):272-9.

Aspirin remains the first choice drug for the primary and secondary prevention of cardiovascular events. For the secondary prevention of cerebrovascular events, aspirin remains an effective drug, particularly in combination with dipyridamole. In aspirin intolerant patients, clopidogrel and ticlopidine are both viable alternatives for the prevention of both cardiovascular and cerebrovascular events, particularly clopidogrel, which has a much more favorable side effect profile. Clopidogrel and ticlopidine are unequivocally the drugs of choice for prevention of subacute thrombosis in patients undergoing implantation of intracoronary stents. Recent data from the CURE trial suggests that the combination of aspirin and clopidogrel may be more effective in preventing ischemic events in patients presenting with acute coronary syndromes. Given that clopidogrel is costly, combination therapy may be reserved for the highest risk patients. There are no clear guidelines on the optimal therapy of patients who develop recurrent myocardial infarctions despite prior aspirin therapy. In this setting, one may speculate that the addition of clopidogrel to aspirin would be beneficial. Dipyridamole has little role in the modern cardiovascular medicine with the exception of patients with prosthetic valves who continue to have embolic complications despite adequate warfarin treatment. Cilostazol is an effective drug for patients with limiting claudication. Glycoprotein IIb/IIIa inhibitors are expensive intravenous drugs that are reserved mainly for use in the setting of coronary angioplasty with or without stenting. Further studies are in progress to evaluate the long-term benefit of combination therapy with aspirin and clopidogrel in patients with cerebrovascular disease (MATCH trial).

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