Primary Prevention of CV Disease & Antiplatelet Drugs

primary prevention

pts with risk factors but not developed clinically manifested CVD

secondary prevention

pts with established CVD and preventing it from progressing

primary prevention CVD guidelines

ACC/AHA 2019

1. low dose aspirin (75-100mg) for primary prevention for 40-70 yo with higher ASCVD risk but not increased bleeding irsk

2. low dose aspirin shouldn’t be admin routinely for primary prevention of ASCVD for >70 yo

3. low dose aspirin shouldn’t be admin for primary prevention of ASCVD at any age if increased risk of bleeding

US Preventative Services Task Force Recommendation Statement

• risk-benefit analysisi for 40-59 yo with ≥10% ASCVD risk

• DO NOT use low dose aspirin primary prevention for ≥60 yo

antiplatelet meds

• thromboxane inhibitors (aspirin)

• ADP antagonists (clopidogrel, prasugrel, ticagrelor, cangrelor)

• GP IIb/IIIa inhibitors (abcixumab, eptifibatide)

aspirin MOA

irreversibly inhibits COX —> inhibits platelet aggregation

aspirin AEs

• bleeding

• GI ulcers/bleeding

• rare - intracranial hemorrhage

aspirin monitoring

CBC

fecal blood test

aspirin CIs

<16 yo with viral illness (reye’s)

asthma, rhinitis, nasal polyps

aspirin drug interxns

antithrombotics

ibuprofen (space them out)

secondary prevention meds

P2Y12 inhibitors