Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease

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Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease
Dual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease
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Contents
Contributors
Preface
1 - Platelets and arterial disease—initiation, progression, and destabilization of atherosclerotic vascular disease
	Initiation of atherosclerotic disease
	Transition to vulnerable plaque
	Thrombosis of the ruptured plaque
	Summary
	References
2 - Platelet physiology and 
pharmacology—relevant considerations for patient care
	Introduction
	Platelet physiology
		Formation and structure
		Platelet activation
			Initiation phase
			Extension phase
			Perpetuation phase
	Antiplatelet pharmacology
		Cyclooxygenase 1 inhibitor
			Aspirin
		P2Y12 inhibitors
			Clopidogrel
			Prasugrel
			Ticagrelor
			Cangrelor
		Thrombin receptor antagonists
			Vorapaxar
		Glycoprotein IIb/IIIa inhibitors
			Abciximab
			Eptifibatide
			Tirofiban
		Phosphodiesterase inhibitor
			Cilostazol
	Additional targets
	References
3 - The development of dual 
antiplatelet therapy: physiologic and clinical implications of multiple pathway inhibit ...
	Introduction
	Aspirin monotherapy
	Thienopyridines
		Ticlopidine
		Clopidogrel
		Prasugrel
	Dipyridamole
	Cilostazol
	Ticagrelor
	Conclusions
	References
4 - Acute coronary syndromes and percutaneous coronary intervention—current recommendations for dual antiplatelet t ...
	Introduction
	Rationale for the standard 12-month dual antiplatelet therapy
	Randomized trials assessing antiplatelet therapy
		Randomized trials assessing P2Y12 inhibitor choice
		Randomized trials assessing aspirin dosing or aspirin-free strategies
		Randomized trials of de-escalation, platelet function, and genotype types
	Current clinical practice guidelines
		Percutaneous coronary intervention for acute coronary syndrome
		Stable coronary artery disease
		Coronary artery bypass graft
		Switching of P2Y12 inhibitors
		Platelet function testing and genetic testing
	Risk stratification for ischemic and bleeding events
	Do the current guidelines reflect the data?
	Conclusion
	References
5 - Peripheral arterial disease—a different kind of arterial disease? The role of antiplatelet therapy in the preve ...
	Introduction
	Patients with peripheral arterial disease alone without clinically manifest coronary artery or cerebrovascular disease
	Patients with peripheral arterial disease and clinically manifest coronary artery or cerebrovascular disease
	Patients with symptomatic peripheral arterial disease
		Aspirin monotherapy
		P2Y12 inhibitor monotherapy
		Dual antiplatelet therapy
		Protease-activated receptor 1 antagonist
		Anticoagulation
	Endovascular revascularization
	Surgical revascularization
	Plaque and lesion characteristics of peripheral arterial disease versus coronary artery disease
	Summary
	References
6 - Cerebrovascular disease—what is the role of dual antiplatelet therapy for the prevention and treatment of ische ...
	Introduction
	Mechanisms of stroke
	Guidelines and current practice
	Primary prevention
	Treatment and secondary prevention
		Choice of antiplatelet drugs
		Antiplatelet regimens
		Antiplatelet therapy duration
	Future perspective
	Conclusion
	References
7 - Competing risks in the duration of dual antiplatelet therapy—the case for shorter treatment
	Introduction
	Competing risks of ischemia and bleeding: why bleeding is important and what is its clinical impact?
	Elements associated with a high bleeding risk
	Strategies to reduce bleeding: the case for a short dual antiplatelet therapy duration
	Current evidence for individualization of duration of dual antiplatelet therapy
	Dual antiplatelet therapy decision-making in patients with concurrent high ischemic and bleeding risk
	Conclusions
	References
8 - Dual antiplatelet therapy may prevent coronary ischemic events beyond one year—the case for extended treatment
	Introduction
	Rationale for prolonged dual antiplatelet therapy
	Randomized trials assessing prolonged dual antiplatelet therapy
	Moving beyond clopidogrel
	High-risk patient populations
	Current state of guidelines
	Conclusion
	References
9 - Clinical risk scores: a tool to understand bleeding and thrombotic risk
	Introduction
	Dual antiplatelet therapy: competing bleeding and thrombotic risks
	The perfect risk score
	Interpreting risk score quality assessment
	The early applications of risk scores in percutaneous coronary intervention
	The DAPT score
	The PARIS score
	The PRECISE-DAPT score
	Applying risk scores to practice
	Oral anticoagulation
	The future of dual antiplatelet therapy risk scores
	Conclusion
	References
10 - Moving from dual antiplatelet therapy to monotherapy based on P2Y12 receptor blockade—why it could be a novel  ...
	Introduction
	Overview of platelet function and pathophysiology
	Rationale for dual antiplatelet therapy
	The rise and fall of aspirin
		The legacy of aspirin
		The downfall of aspirin
	Rationale for aspirin withdrawal
		Evidence at the molecular level
		Evidence from clinical trials
	Clinical trials evaluating P2Y12 inhibitor monotherapy
		SMART-CHOICE
		STOPDAPT-2
		GLOBAL LEADERS
		TWILIGHT
		TICO
	Ongoing and future P2Y12 inhibitor monotherapy trials
	Conclusion
	References
11 - The conundrum of simultaneous antiplatelet and anticoagulant therapy: how to solve it?
	Options to reduce the bleeding risk of combined antiplatelet and anticoagulant therapy
		Radial access
		Various use of P2Y12 inhibitors
		Dropping aspirin
		Non–vitamin K antagonist oral anticoagulants
		Use of proton pump inhibitors
		Avoidance of nonsteroidal anti-inflammatory drugs
	Future perspectives
	Conclusion
	References
12 - A look into the future
Index
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