Antiplatelet therapy in the prevention of cardiovascular diseases.

Antiplatelet agents have been studied in a number of clinical trials to evaluate their efficacy in the prevention of ischemic cardiovascular events related to platelet-rich thrombi. Acetylsalicylic acid (ASA) is definitely effective in the hospital phase of acute myocardial infarction; it also prevents cardiovascular events but not anginal attacks in patients with unstable angina and reduces the rate of occlusion of coronary artery bypass grafts. ASA is often used in the post-infarction period, even though anticoagulant therapy is probably more effective; it is also effective in patients with transient ischemic attacks in the brain. Ticlopidine is the treatment of choice in patients with major stroke and in those with peripheral vascular ischemia; it can also be considered a valid alternative to ASA in the management of transient ischemic attacks and unstable angina. There is at the moment little role for antiplatelet agents in the primary prevention of cardiovascular disease.