Anti-aggregants in 1990

Antiplatelet drugs are increasingly used in the prevention of arterial thrombosis. Aspirin in doses of circa 300 mg day may be recommended for the primary prevention of myocardial infarction, but only in subjects at moderate to high risk of cardiovascular disease. Antiplatelet agents are useless in stable angina, but aspirin reduced by about 50% the risk of myocardial infarction and the overall mortality rate among patients with unstable angina. A lower dose of aspirin (150 mg/day) also reduces mortality by 23% in the acute phase of myocardial infarction. In doses of 300 mg/day, aspirin is useful in the secondary prevention of myocardial infarction and reduces the overall mortality rate by 15%. Various antiplatelet agents, including aspirin (alone or combined with dipyridamole) and ticlopidine, have proved useful to avoid thrombosis in aorto-coronary grafts, provided treatment begins at the latest 6 hours after surgery. The usefulness of antiplatelets has been well established in the prevention of immediate reocclusion following coronary angioplasty, but not in the prevention of late reocclusion. Aspirin and ticlopidine are useful in the extracorporeal circulation techniques. In patients with cardiac valve prosthesis, antivitamin K anticoagulants are still indispensable, but their antithrombotic effect can be reinforced by dipyridamole or aspirin. Diuretics probably provide the best primary protection against cerebrovascular accidents, although medium doses of aspirin may be considered in elderly people at high risk of such accidents. Aspirin (alone or combined with dipyridamole) and ticlopidine may be recommended for the secondary prevention of cerebral ischaemic accidents.(ABSTRACT TRUNCATED AT 250 WORDS)