Search for an optimal efficacy-to-safety ratio for anti-platelet therapy of ischemic heart disease

Abstract

Acetylsalicylic acid remains the basis of anti-platelet therapy for stable ischemic heart disease (IHD), including conditino after coronary artery bypass grafting. Double anti-platelet therapy (APT) consisting of acetylsalicylic acid and a P2Y12 receptor inhibitor (clopidogrel, prasugrel, ticagrelor) reduces the risk of recurrence of major ischemic complications in patients with acute coronary syndromes (ACS) and/or those who underwent percutaneous coronary intervention (PCI), but inevitably increases the risk of major bleeding compared with anti-platelet monotherapy. The principle of personified treatment is implemented on the basis of an assessment of the patient’s clinical status (stable ischemic heart disease or ACS), the ratio of the ischemic and bleeding risks, strategies of management. The review presents the evidence-base to support anti-platelet therapy of stable IHD and ACS in conservative treatment and myocardial revascularization, which forms the basis of the current clinical guidelines. According to the current views the optimal duration of APT after ACS and PCI can vary from 1 to 48 months and continues to be studied in randomized trials. Most recently, the principle of de-escalation of anti-platelet therapy after ACS and PCI has been developed, taking into account the actively discussed findings of clinical projects published in the second half of 2017.

Keywords

• anti-platelet therapy
• ischemic heart disease
• acute coronary syndromes
• acetylsalicylic acid
• clopidogrel
• prasugrel
• ticagrelor