Postgraduate medicine
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Postgraduate medicine · Jan 2009
ReviewThe potential role of prasugrel in secondary prevention of ischemic events in patients with acute coronary syndromes.
Acute coronary syndromes (ACS) are life-threatening manifestations of coronary artery disease, occurring when a thrombus forms at the site of atherosclerotic plaque rupture or fissuring. Almost all patients discharged from the hospital after an ACS (myocardial infarction or unstable angina) in the United States receive antiplatelet therapy. Current recommendations for post-ACS antiplatelet therapy are aspirin 75 to 162 mg/day indefinitely for all patients, plus a thienopyridine (currently clopidogrel 75 mg/day) for > or = 12 months in those receiving stents unless there is a high risk of bleeding. ⋯ In clinical trials, the combination of prasugrel + aspirin reduced the risk of a second ischemic event by 19% compared with clopidogrel + aspirin. There is a small increase in the risk of bleeding with dual antiplatelet therapy, but the benefit still outweighs the risk in most patients. Patients with a history of transient ischemic attack or stroke should not receive prasugrel + aspirin because of increased risk of events.
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Postgraduate medicine · Jan 2009
ReviewAppropriate secondary prevention of acute atherothrombotic events and strategies to improve guideline adherence.
The use of guideline-recommended secondary prevention measures is essential for reducing the risk of subsequent events and mortality in patients who have survived an acute atherothrombotic event or have peripheral arterial disease. Although initial hospitalization provides an ideal environment to initiate such therapies, implementation of effective longterm prevention strategies is hindered by the absence of a systematic approach. ⋯ Recognizing the importance of a systematic approach to discharge planning, numerous hospital-based initiatives have been established. In conjunction with effective lines of communication between hospital and primary care teams, initiation of the most effective secondary prevention strategy at the time of hospital discharge will help to ensure optimal long-term management of patients after an atherothrombotic event.