Abstract
Platelets exhibit a major role in development and progression of atherothrombosis. The normal function of platelets is to secure hemostasis at sites of vascular injuries. Abnormal endovascular structure may result in excessive platelet function with consequence of progressive or acute reduction in vascular lumen and cessation of blood flow. Despite succeeding in averting bleeding, total occlusion of a vessel leads to inevitable ischemia with eventual cell death upon lack of blood supply clinically manifesting as myocardial infarction in coronary vessels, cerebral infarction (stroke) in cerebral vessels, or peripheral gangrene in peripheral arterial disease. Antiplatelets long have been used to halt the process of atherothrombosis preventing further tissue damage at the expense of bleeding as well as other side effects. In this review, the role of antiplatelets in primary and secondary prevention of thrombotic events is explored in light of evidence based clinical practice.
Highlights
Acute coronary syndromes (ACS) are increasing in incidence throughout the world with clear heavy burden on humanity
Current guidelines reflect the superiority of newer P2Y12 inhibitors as both agents are recommended in STEMI patients replacing clopidogrel [129131]
The effect of aging on vascular patency is magnified by adopting unhealthy lifestyle resulting in atherothrombosis presenting as ACS, myocardial infarction (MI), transient ischemic attack (TIA), or stroke either alone or in combination
Summary
Acute coronary syndromes (ACS) are increasing in incidence throughout the world with clear heavy burden on humanity. Atherothrombotic manifestation of ischemia relies on the presence or absence of collateral circulation. Lack of such collaterals, at the cellular level, means only one outcome and that is death of cells fed by the occluded vessel. Atherothrombosis is a simple term refers to thrombus formation on top of atherosclerotic plaque disruption of diseased arterial lumen. Platelets are activated in response to disrupted atheromatous plaque in an attempt of mending the vessel wall, in the presence of atherosclerosis; thrombus formation narrows the lumen resulting in ischemia that may extend to total vessel occlusion. Combination of antiplatelet therapies is another concern increasing the risk for bleeding while achieving modest platelet inhibition as well as modest reduction of thrombotic events [30-35]. The function of platelets may be altered either by reduction in platelet count or decreased function in the setting of normal platelet count in several disorders including renal disease, hepatic disease, hematological malignancies, infectious diseases, disseminated intravascular coagulopathy, pancreatitis, immune-mediated thrombocytopenia, and certain medications
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