Author/Editor     Poredoš, Pavel; Ježovnik, Mateja
Title     Is aspirin still the drug of choice for management of patients with peripheralarterial disease?
Type     članek
Vol. and No.     Letnik 42Letnik 2
Publication year     2013
Volume     str. 88-95
ISSN     0301-1526 - VASA. Zeitschrift fur Gefasskrankheiten
Language     eng
Abstract     Antiplatelet drugs represent one of the basic options for management of patients with different atherosclerotic diseases. Aspirin is the oldest and most often prescribed antiplatelet drug. The efficacy of aspirin depends on the clinical characteristics of the treated population and probably also on the type or location of atherosclerotic disease. It seems that it is most effective in coronary patients with clinically unstable disease, less effective in prevention of cerebrovascular incidents, and its efficacy is uncertain in peripheral artery disease (PAD) patients. One of the first meta-analyses (Antithrombotic TrialistsŽ Collaboration - ATC) indicated that antiplatelet drugs also significantly reduce cardiovascular events in patientswith PAD. However, only one third of the PAD patients included were treated with aspirin, while the rest received other anti-platelet drugs. The latest ATC meta-analysis of randomized control trials of aspirin therapy involving patients with diabetes and PAD demonstrated no benefit of aspirin inreducing cardiovascular events. Also in patients with preclinical PAD (pathological ankle brachial index) aspirin did not result in a significant reduction of vascular events. The new anti-platelet drugs prasugrel, ticagrelor and picotamide seem to be more effective than aspirin in PAD patients, particularly in diabetic patients with PAD. In conclusion, antiplatelet drugs are effective in prevention of cardiovascular events in different atherosclerotic diseases, including PAD. However, recent studies indicated that in PAD patients aspirin is less effective than in coronary artery disease. New anti-platelet drugs showed marginal superiority over aspirin without definite advantages. Aspirin thus remains the first line of antiplatelet drug for secondary prevention of cardiovascular events in PAD patients and clopidogrel as its effective alternative. Further, new studies onPAD patients are necessary to better define the role of anti-platelet agentsin these patients and one of the promising ways of access to anti-platelet treatment would be personalized anti-platelet therapy.
Keywords     kardiovaskularne bolezni
aspirin
zdravljenje