![]() ![]() The mechanism is not fully understood but it is thought to act by inhibiting adenosine uptake into platelets and reducing ADP-induced aggregation.The combination is recommended for 12 months only - beyond which there is doubtful clinical benefit.Stent thrombosis occurred during treatment with clopidogrel or.Immediate PCI is necessary for ST-segment elevation myocardial infarction (STEMI) or.NICE guidance recommends prasugrel in combination with aspirin in ACS patients undergoing primary PCI when:.Prasugrel, in combination with aspirin, is licensed for the prevention of atherothrombotic events in patients with acute coronary syndrome undergoing percutaneous coronary intervention.It inhibits the binding of adenosine diphosphate to its platelet receptor, preventing ADP-mediated up-regulation of glycoprotein (GP) IIb/IIIa receptor, again blocking amplification of platelet aggregation. For people who have had a myocardial infarction, only if aspirin is contra-indicated or not tolerated.For people who have had an ischaemic stroke or who have peripheral arterial disease or multivascular disease or.The National Institute for Health and Care Excellence (NICE) recommends clopidogrel as an option to prevent occlusive vascular events:.Clopidogrel monotherapy may be an alternative when aspirin is contra-indicated, for example in patients with aspirin hypersensitivity, or when aspirin is not tolerated despite the addition of a proton pump inhibitor.The use of clopidogrel with aspirin increases the risk of bleeding.Clopidogrel is also used, in combination with low-dose aspirin, for the prevention of atherothrombotic and thromboembolic events in patients with atrial fibrillation (and at least one risk factor for a vascular event), and for whom warfarin is unsuitable.Clopidogrel is used for the prevention of atherothrombotic events in patients with a history of symptomatic ischaemic disease (eg, ischaemic stroke).If there is a high risk of gastro-intestinal bleeding, a proton pump inhibitor can be added.If aspirin is not tolerated, clopidogrel should be considered as an alternative. Following transcatheter aortic valve implantation (TAVI), aspirin monotherapy is considered rather than dual antiplatelet therapy.It is also used for intermittent claudication, for stable angina and acute coronary syndromes, for use following placement of coronary stents and for use in stroke. Aspirin is given following coronary bypass surgery.The use of aspirin in primary prevention of cardiovascular disease, in patients with or without diabetes, or hypertension, is not recommended. ![]() ![]() High blood pressure should be controlled before aspirin is given. Long-term use of low-dose aspirin is recommended in patients with established cardiovascular disease (secondary prevention).Aspirin also has analgesic, anti-inflammatory and antioxidant properties.Antithrombotic action derives from reduction in thromboxane A2.Aspirin irreversibly inhibits cyclo-oxygenase, which catalyses the production of thromboxane and prostaglandins. ![]()
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