The dogma of aspirin: a critical review of evidence on the best monotherapy after dual antiplatelet therapy

Thrombosis Journal

Claudio Cimminiello¹  Mauro Molteni¹  Hernan Polo Friz¹ 

[1] Department of Medicine, Vimercate Hospital Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy

关键词: Clopidogrel;    Aspirin;    Evidence-based practice;    Platelet aggregation inhibitors;   

Others  :  1224908
DOI  :  10.1186/s12959-015-0059-8

 received in 2015-01-29, accepted in 2015-06-04,  发布年份 2015

【 摘 要 】

Dual antiplatelet therapy based on the combination of an adenosine diphosphate (ADP)-receptor antagonist plus aspirin has demonstrated to be more effective in reducing the rate of major ischemic vascular events compared to aspirin monotherapy in some clinical settings. The current controversy on the duration of dual antiplatelet therapy should not conceal another major issue: the choice of the more appropriate antiplatelet monotherapy after the dual treatment phase. The aim of this article is to critically analyze the available evidence in this topic.

Data from studies like CAPRIE, MATCH, PROFESS, CHANCE, DAPT and others, raise questions as why antiplatelet monotherapy after the dual phase should only be based on aspirin, in spite of a lack of evidence surprisingly not highlighted by key opinion leaders and experts.

We conclude that, whether ADP-receptor antagonist rather than aspirin may be proposed as monotherapy seems not only have no answer but also not place in the current specialists’ analysis, as if a dogmatic approach were prevalent. Perhaps the time for an open debate on these topics is ripe.

【 授权许可】

   
2015 Polo Friz et al.

【 图 表 】

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【 参考文献 】

• [1]Patrono C, Andreotti F, Arnesen H, Badimon L, Baigent C, Collet JP et al.. Antiplatelet agents for the treatment and prevention of atherothrombosis. Eur Heart J. 2011; 32(23):2922-32.
• [2]Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK et al.. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001; 345:494-502.
• [3]Chen ZM, Jiang LX, Chen YP, Xie JX, Pan HC, Peto R et al.. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005; 366:1607-21.
• [4]Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P et al.. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005; 352:1179-89.
• [5]Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK et al.. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001; 358:527-33.
• [6]Steinhubl SR, Berger PB, Mann JT, Fry ET, DeLago A, Wilmer C et al.. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002; 288:2411-20.
• [7]Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P et al.. Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA. 2005; 294:1224-32.
• [8]Alonso-Coello P, Bellmunt S, McGorrian C, Anand SS, Guzman R, Criqui MH et al.. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians EvidenceBased Clinical Practice Guidelines. Chest. 2012; 141:e669S-90.
• [9]Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L et al.. American College of Cardiology Foundation Task Force; American Heart Association Task Force. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 61(14):1555-70.
• [10]Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C et al.. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013; 369:11-9.
• [11]Wang Y, Johnston SC, Wang YO. Clopidogrel with aspirin in minor stroke or transient ischemic attack. N Engl J Med. 2013; 369(14):1376-7.
• [12]A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996; 348:1329-39.
• [13]Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001; 345:494-502.
• [14]Steinhubl S, Berger P. What is the role for improved long-term antiplatelet therapy after percutaneous coronary intervention? Am Heart J. 2003; 145(6):971-8.
• [15]Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M et al.. MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004; 364(9431):331-7.
• [16]Fork FT, Lafolie P, Tóth E, Lindgärde F. Gastroduodenal tolerance of 75 mg clopidogrel versus 325 mg aspirin in healthy volunteers. Scand J Gastroenterol. 2000; 35:464-9.
• [17]van Gijn J, Algra A. Aspirin and stroke prevention. Thromb Res. 2003; 110(5–6):349-53.
• [18]Hankey GJ, Sudlow CL, Dunbabin DW. Thienopyridine derivatives (ticlopidine, clopidogrel) versus aspirin for preventing stroke and other serious vascular events in high vascular risk patients. Cochrane Database Syst Rev. 2000; 2:CD001246.
• [19]Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE et al.. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006; 354:1706-17.
• [20]Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012; 367:817-25.
• [21]Sacco RL, Diener HC, Yusuf S, Cotton D, Ounpuu S, Lawton WA et al.. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008; 359(12):1238-51.
• [22]Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al.. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011; 124(23):e574-651.
• [23]Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V et al.. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014; 35:2541-619.
• [24]Mauri L, Kereiakes DJ, Yeh RW, Driscoll-Shempp P, Cutlip DE, Steg PG et al.. DAPT Study Investigators. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014; 371(23):2155-66.
• [25]Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M et al.. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med. 1996; 334(17):1084-9.
• [26]Gaglia MA, Waksman R. Systematic review of thienopyridine discontinuation and its impact upon clinical outcomes. Eur Heart J. 2011; 32(19):2358-64.
• [27]Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002; 324:71-86.
• [28]Berger JS, Krantz MJ, Kittelson JM, Hiatt WR. Aspirin for the prevention of cardiovascular events in patients with peripheral artery disease: a meta-analysis of randomized trials. JAMA. 2009; 301:1909-19.