Aspirin-free strategies in cardiovascular disease and cardioembolic stroke prevention

In patients with manifestations of cardiovascular disease, acetylsalicylic acid (popularly known as aspirin) has been the mainstay of treatment for decades owing to its capacity to reduce the risk of ischaemic events. Accordingly, novel antithrombotic therapies have been traditionally tested on a ba...

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Bibliographic Details
Published in:	Nature reviews cardiology Vol. 15; no. 8; pp. 480 - 496
Main Authors:	Capodanno, Davide, Mehran, Roxana, Valgimigli, Marco, Baber, Usman, Windecker, Stephan, Vranckx, Pascal, Dangas, George, Rollini, Fabiana, Kimura, Takeshi, Collet, Jean-Philippe, Gibson, C Michael, Steg, Philippe Gabriel, Lopes, Renato D, Gwon, Hyeon-Cheol, Storey, Robert F, Franchi, Francesco, Bhatt, Deepak L, Serruys, Patrick W, Angiolillo, Dominick J
Format:	Journal Article
Language:	English
Published:	England Nature Publishing Group 01.08.2018
Subjects:	Acids Aspirin - therapeutic use Cardiovascular disease Cardiovascular Diseases - drug therapy Cardiovascular Diseases - prevention & control Disease prevention Fibrinolytic Agents - therapeutic use Humans Stroke Stroke - drug therapy Stroke - prevention & control
ISSN:	1759-5002, 1759-5010, 1759-5010
Online Access:	Get full text
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Summary:	In patients with manifestations of cardiovascular disease, acetylsalicylic acid (popularly known as aspirin) has been the mainstay of treatment for decades owing to its capacity to reduce the risk of ischaemic events. Accordingly, novel antithrombotic therapies have been traditionally tested on a background of acetylsalicylic acid therapy. Although the adjunctive use of such antithrombotic therapies can potentially further reduce the risk of ischaemic events, these agents are also inevitably associated with an increased risk of bleeding. However, acetylsalicylic acid also increases the risk of bleeding, challenging the paradigm that this agent should remain the cornerstone of antiplatelet treatment when alternative antithrombotic agents are also used. Many antithrombotic compounds are characterized by increased potency and consistent efficacy, which might lessen the need for concomitant acetylsalicylic acid. Accordingly, numerous investigations are testing the hypothesis that acetylsalicylic acid-sparing regimens based on newer antithrombotic agents might have an increased net benefit for individual patients owing to the reduction in bleeding risk, without a trade-off in efficacy. This Review summarizes the state of the art relating to antithrombotic approaches with and without acetylsalicylic acid for the prevention of cardiovascular disease and cardioembolic stroke. Discussion of the scientific rationale, from bench to bedside, for ongoing studies of acetylsalicylic acid-free pharmacological strategies is included.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Literature Review-3 ObjectType-Review-3 content type line 23
ISSN:	1759-5002 1759-5010 1759-5010
DOI:	10.1038/s41569-018-0049-1