Antiagregacijsko zdravljenje - indikacije, učinkovitost in zapleti = Antiplatelet therapy - indications, efficacy and complications
Blinc, Aleš
The complications of advanced atherosclerosis, most importantly myocardial infarction and ischemic stroke, are the leading cause of mortality in the developed world. Oral antiplatelet treatment has ...an important role in the secondary prevention of ischemic events. Low dose aspirin,100-325 mg/day, is the oldest and most extensively tested antiplatelet drug regimen, which reduces ischemic events in high risk groups by about 25 percent, but increasesthe risk of upper gastrointestinal bleeding about 2-fold. Combining aspirin with dipyridamole provides better protection against ischemic stroke than aspirin alone in patients with established cerebrovascular disease. Aspirin slightly increases the risk of intracranial bleeding and is therefore not recommended for primary prevention of atherosclerosis in low risk groups. Ticlopidine is an antiplateiet drug and in combination with aspirin it provides excellent protection against thrombosis of intracoronary stents. Its use has been associated with serious side effects such as leukopenia and thromboic thrombocytopenic purpura; therefore ticlopidine has been largely replaced by the related, but safer drug clopidogrel. Clopidogrel laas been about 9 percent more effective than aspirin in preventing recurrent ischemic events in patients with coronary heart disease, cerebrovascular disease or peripheral arterial disease; but its cost is about 20 times higher than that of aspirin.
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