Dual antiplatelet therapy (DAT) with acetylsalicylic acid and a thienopyridine agent (clopidogrel) as secondary prevention for patients with atherosclerotic coronary artery disease has been proven effective in those with unstable angina or acute coronary syndromes and following a percutaneous coronary intervention. At present, detailed guidelines provide specific guidance to clinicians regarding which patients to treat, the specific safe and effective combination regimen to use, and the appropriate duration of DAT. This evidence applies to the prevention of cardiovascular events in older adults; however, special considerations should be undertaken when using DAT in older adults due to their overall increased propensity for bleeding complications and potential concomitant medication use for comorbid conditions. This article provides an overview of the evidence for DAT, with a focus on treating older adults.
Key words: cardiovascular protection, clopidogrel, acetylsalicylic acid, acute coronary syndromes, coronary stenting.
Antiplatelet agents are the cornerstone of secondary prevention for patients who present with an ischemic stroke or transient ischemic attack (TIA). At present, monotherapy with acetylsalicylic acid (ASA) or clopidogrel or the combination regimen of ASA plus extended-release dipyridamole are recommended as first-line options in the stroke prevention guidelines. The combination of ASA and clopidogrel is not routinely recommended for secondary stroke prevention, since it has been shown to offer no therapeutic advantage and an increased risk of bleeding. The clear answer as to whether one or two antiplatelet agents are better for the secondary prevention of ischemic stroke events in older adults depends upon the combination of agents, as well as the monotherapy comparator.
Key words: stroke prevention, clopidogrel, acetylsalicylic acid, dipyridamole, antiplatelet agents.
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