Platelets have a central role in thrombosis, including in the pathogenesis of coronary artery disease and acute coronary syndromes. Therapies that target the platelet are, therefore, a vital component of our armamentarium against ischemic cardiovascular events. Antiplatelet therapy is a fast-moving area of research that is of interest not only to cardiologists, but also to general internists, surgeons, medical geneticists, as well as policy and decision makers. This focus issue features five Review articles and a Perspectives opinion piece, written by leading experts, which cover the current major themes in the field.
An NPG library relevant Original research, Reviews, Commentaries, Case Studies, Letters and Research highlights is also provided.
RESEARCH HIGHLIGHTS
Antiplatelet therapy: Discontinuation of low-dose aspirin reverses its prophylactic effect
Gregory B. Lim
doi:10.1038/nrcardio.2011.123
Nature Reviews Cardiology 8, 542 (2011)
Antiplatelet therapy: Surgery should not interrupt treatment
Alexandra King
doi:10.1038/nrcardio.2011.125
Nature Reviews Cardiology 8, 540 (2011)
REVIEWS
The evolution of antiplatelet therapy in cardiovascular disease
Omair Yousuf & Deepak L. Bhatt
doi:10.1038/nrcardio.2011.96
Nature Reviews Cardiology 8, 547-559 (2011)
In this state-of-the-art Review, Drs Yousuf and Bhatt appraise landmark trials of various existing, new, and investigational antiplatelet agents. They also discuss the optimal dosing and timing of antiplatelet medications in relation to percutaneous and surgical intervention, and the challenges associated with high platelet reactivity in patients receiving dual antiplatelet therapy.
The pharmacogenetics of antiplatelet agents: towards personalized therapy?
Tariq Ahmad, Deepak Voora & Richard C. Becker
doi:10.1038/nrcardio.2011.111
Nature Reviews Cardiology 8, 560-571 (2011)
Evidence is increasing that genetic variation between patients underlies the considerable variability in their response to antiplatelet agents, and, therefore, in clinical outcomes. Drs Ahmad, Voora, and Becker review the genetic loci that seem to have a role in determining platelet response; genes that are involved in the absorption, metabolic activation, and biological activity of aspirin and clopidogrel. Finally, they discuss, in the context of ongoing clinical trials, the merits and potential dangers of using commercial genetic testing and pharmacogenetics to personalize antiplatelet therapy to individual patients.
Assessment of oral antithrombotic therapy by platelet function testing
Udaya S. Tantry & Paul A. Gurbel
doi:10.1038/nrcardio.2011.107
Nature Reviews Cardiology 8, 572-579 (2011)
Dual and triple antiplatelet therapies prevent ischemic events in high-risk patients with coronary artery disease or during percutaneous coronary interventions, but can cause bleeding complications. In this Review, Dr. Tantry and Dr. Gurbel discuss the utility of platelet function assays for the assessment of ischemic and bleeding risk to personalize antithrombotic combination therapies.
Cost-effectiveness of oral antiplatelet agents—current and future perspectives
Suzanne V. Arnold, David J. Cohen & Elizabeth A. Magnuson
doi:10.1038/nrcardio.2011.119
Nature Reviews Cardiology 8, 580-591 (2011)
Drs Arnold, Cohen, and Magnuson review the published cost-effectiveness analyses of oral antiplatelet therapies for various clinical settings. This information is of increasing importance, given the enormous health-care expenditure worldwide, the advent of novel oral antiplatelet drugs, and the availability in many countries of generic clopidogrel, which is cheaper than the branded version and likely to improve its cost-effectiveness compared with alternative medications.
Managing adverse effects and drug–drug interactions of antiplatelet agents
Arun Kalyanasundaram & A. Michael Lincoff
doi:10.1038/nrcardio.2011.128
Nature Reviews Cardiology 8, 592-601 (2011)
Antiplatelet agents effectively reduce the incidence of ischemic events associated with plaque rupture but can cause adverse effects, most notably hemorrhage. Drs Kalyanasundaram and Lincoff address key adverse effects that are associated with antiplatelet agents and discuss potential interactions between these drugs and other medications.
PERSPECTIVES
The role of aspirin for stroke prevention in atrial fibrillation
Gregory Y. H. Lip
doi:10.1038/nrcardio.2011.112
Nature Reviews Cardiology 8, 602-606 (2011)
Patients with atrial fibrillation are at substantial risk of thromboembolism and acute ischemic stroke. Professor Gregory Lip gives his perspective on the role of using the antiplatelet agent aspirin for stroke prevention in these patients, compared with warfarin and novel anticoagulant drugs, supported by data from randomized, clinical trials and guideline recommendations.
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