EVOLVING LANDSCAPE OF ANTITHROMBOTIC THERAPY FOR ATHEROSCLEROSIS (Invited Lecture)



Deepak L. Bhatt MD, MPH, Brigham and Women's Hospital, Boston, MA, USA

Aspirin remains the foundation of antiplatelet therapy. Trials soon to report will clarify its role in primary prevention. The role of aspirin in secondary prevention seems quite secure, though recent data have raised concerns about whether the enteric coating might impede its absorption and antiplatelet effects. Clopidogrel, now generic, remains in common use worldwide for high risk secondary prevention, as monotherapy in patients with myocardial infarction, ischemic stroke, or symptomatic peripheral artery disease. It also remains an important part of dual antiplatelet therapy after stenting in stable coronary artery disease. In acute coronary syndromes, dual antiplatelet therapy seems particularly important for at least a year of therapy, regardless of whether patients are treated with stents or medical therapy; ticagrelor is being used instead of clopidogrel in patients at low bleeding risk. The combination of aspirin with low dose rivaroxaban may soon provide an additional option for stable coronary or peripheral artery disease.