Hospital Practices and Research

Is Aspirin Still the Cornerstone of Antiplatelet Therapy in Patients With Coronary Artery Disease? An Historical and Practical Narrative Review

Document Type : Review Article

Authors

Carol Gravinese 1
Matteo Bianco 1
Enrico Cerrato 2
Paola Destefanis 1
Alessia Luciano 1
Alessandro Bernardi 3
Simone Bellucca 1
Ferdinando Varbella 2
Fiorenzo Gaita 3
Roberto Pozzi 1

1 Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Torino, Italy

2 Interventional Cardiology Unit, Infermi Hospital, Rivoli and San Luigi Gonzaga University Hospital, Orbassano, Italy

3 Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy

https://doi.org/10.15171/hpr.2017.24
Abstract
Aspirin is an irreversible and non-selective inhibitor of cyclo-oxygenase. It represents the cornerstone of antiplatelet therapy and is used in secondary prevention of cardiovascular disease. Disagreement over the optimal maintenance dosage still exists; in America and Europe the most used doses of aspirin are 81 mg and 100 mg daily, respectively. There is also debate on the formulation and route of administration of the loading dose. The latest studies advise chewable and non-enteric coated aspirin; intravenous administration represents an alternative for unconscious or shocked patients. Aspirin hypersensitivity is characterized by the onset of respiratory, mucocutaneous, and systemic symptoms. It is marginally considered, but its prevalence is significant. International cardiologic guidelines only report the possibility of desensitizing intolerant patients or, alternatively, administering one single antiplatelet agent. Desensitization can induce a temporary tolerance to the drug and consists of the administration of sequential and incremental doses of aspirin. Rapid desensitization protocols have proven to be safe and effective in the vast majority of cases, and they should be included in the management of these patients. New studies are being carried out comparing aspirin with other antiplatelet agents, and the results will be available shortly.

Keywords

Coronary Artery Disease/Therapy
Drug Therapy
Combination Drug-Eluting Stents
Platelet Aggregation Inhibitors/Administration and Dosage
Platelet Aggregation Inhibitors/Adverse Effects
Percutaneous Coronary Intervention
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Hospital Practices and Research
Volume 2, Issue 4 - Serial Number 8
Autumn 2017
Pages 94-101

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