21 - Antiplatelet Therapy in Cardiovascular Medicine

Abstract

Once thought to be solely a matter of cholesterol deposition in arterial walls, atherosclerosis and, in particular, thrombosis of an atherosclerotic lesion is now known to be dependent on activation and deposition of platelets aided by the coagulation system. Although aspirin had been used as an anti-inflammatory and antipyretic agent since 1900, it wasn’t until 1970 that aspirin was discovered to have powerful and durable antiplatelet activity. Over the past several decades, an enormous amount of research has revealed both the role of platelets in atherogenesis and, in particular, acute thrombosis of the atherosclerotic plaque. This chapter reviews the physiology, pathology, and pharmacology of this event. Modern therapy as it relates to primary and secondary prevention as well as intervention addressing atherosclerotic myocardial ischemia is addressed.