Here is a current review on a topic, which needs some Introspection
For a kid, A stands for apple in kindergarten, while in the school of cardiac pharmacology, A would sound as Aspirin. Such is the importance of this drug, known for its obedient, predictable efficiency in the entire spectrum of CAD right from primary prevention of CAD to emergent primary angioplasty in Cath lab. Most of us will also agree, It is a work horse drug, not only for the cardiologists , but has been an anchor drug in as many critical general medical therapeutics, wherever platelets are to be passivated.
We are well aware of molecular basis of this drugs action. Aspirin impacts most points in the core axis of platelet adhesion , activation and aggregation either directly or indirectly .(Though, its just a COX 1 blocker) Its efficiency is backed by countless papers with authenticated evidence.
Final message
“Now, we, realize Aspirin is being targeted and facing potential elimination “
Why is this happening ?
Aspirin acts by just blocking thromboxane mediated platelet activation , it doesn’t antagonize adenosine triggered activation, hence it is useless is the argument. Some how, our thought faculty is intruded , and unable to realize, the same question can be played in reverse .
P2-Y12 blockers in whatever form & fashion ,helplessly watch thromboxane A2 promoting platelets activation , isn’t ? Please understand, many cases of Clopidogrel and Ticagrelor resistance is apparently related to lack of assistance from the Aspirin .(Genetic P450 heterogenicity story doesn’t explain this fully )
The other concern is Aspirin increases the bleeding risk. It is a perfect irony , this argument is exactly opposite the one discussed above, Implying Aspirin could be a more powerful anti-platelet agent.
It is a duty of every one of us, to find the true reasons for such a bias against Aspirin. However strong the evidence base, (that is being created) It is very difficult to believe , Aspirin is shown the exit door for academic reasons.
Post test
If you want to convert Dual-APT to Mono-APT , which will you jettison ?
A.Aspirin
B.Clopidogrel
C.Ticagrelor
D.Whatever the guideline say.
E.Will leave it to the patient to decide.
Reference
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Dr.S.Venkatesan MD 