What role do antiplatelet agents play in the prevention of coronary artery disease in high-risk patients?

Role of Antiplatelet Agents in Prevention of Coronary Artery Disease in High-Risk Patients

Antiplatelet agents are primarily used for secondary prevention of cardiovascular events in patients with established coronary artery disease (CAD) or those at high risk due to prior events such as myocardial infarction (MI), acute coronary syndrome (ACS), or after coronary interventions like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) ¹.

For high-risk patients, low-dose aspirin (75 mg daily) is the first-line antiplatelet agent recommended for long-term use to reduce the risk of further cardiovascular events ¹.

Dual antiplatelet therapy (DAPT), typically aspirin plus a second agent such as clopidogrel, prasugrel, or ticagrelor, is indicated for up to 12 months following ACS or PCI to further reduce the risk of recurrent ischemic events ¹,².

In stable coronary artery disease undergoing elective PCI, aspirin combined with clopidogrel is initiated and continued for 6 months, with possible adjustment of duration based on bleeding and ischemic risk ¹.

Antiplatelet therapy is not routinely recommended for primary prevention of CAD due to the risk-benefit balance, but is essential in secondary prevention for high-risk patients ¹.