Skip to main content
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1993 Apr;158(4):385–392.

Antiplatelet therapy--Part I.

S H Goodnight 1, B M Coull 1, J H McAnulty 1, L M Taylor 1
PMCID: PMC1022066  PMID: 8317125

Abstract

We summarize current information about aspirin and other antiplatelet drugs in patients with cardiac and vascular disease. For each indication, we briefly summarize the rationale for the use of antiplatelet therapy and describe the findings of relevant clinical trials. We propose recommendations for the use of these agents in clinical practice. Part I covers the use of antiplatelet therapy for the primary and secondary prevention of myocardial infarction, coronary thrombolysis, unstable and chronic stable angina, and coronary artery-saphenous vein bypass grafts. In part II we review the use of antiplatelet agents in coronary angioplasty, atrial fibrillation, artificial cardiac valves, stroke, and peripheral vascular disease.

Full text

PDF
385

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balsano F., Rizzon P., Violi F., Scrutinio D., Cimminiello C., Aguglia F., Pasotti C., Rudelli G. Antiplatelet treatment with ticlopidine in unstable angina. A controlled multicenter clinical trial. The Studio della Ticlopidina nell'Angina Instabile Group. Circulation. 1990 Jul;82(1):17–26. doi: 10.1161/01.cir.82.1.17. [DOI] [PubMed] [Google Scholar]
  2. Bashein G., Nessly M. L., Rice A. L., Counts R. B., Misbach G. A. Preoperative aspirin therapy and reoperation for bleeding after coronary artery bypass surgery. Arch Intern Med. 1991 Jan;151(1):89–93. [PubMed] [Google Scholar]
  3. Cairns J. A., Gent M., Singer J., Finnie K. J., Froggatt G. M., Holder D. A., Jablonsky G., Kostuk W. J., Melendez L. J., Myers M. G. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med. 1985 Nov 28;313(22):1369–1375. doi: 10.1056/NEJM198511283132201. [DOI] [PubMed] [Google Scholar]
  4. Chesebro J. H., Clements I. P., Fuster V., Elveback L. R., Smith H. C., Bardsley W. T., Frye R. L., Holmes D. R., Jr, Vlietstra R. E., Pluth J. R. A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J Med. 1982 Jul 8;307(2):73–78. doi: 10.1056/NEJM198207083070201. [DOI] [PubMed] [Google Scholar]
  5. Chesebro J. H., Fuster V., Elveback L. R., Clements I. P., Smith H. C., Holmes D. R., Jr, Bardsley W. T., Pluth J. R., Wallace R. B., Puga F. J. Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Engl J Med. 1984 Jan 26;310(4):209–214. doi: 10.1056/NEJM198401263100401. [DOI] [PubMed] [Google Scholar]
  6. Clarke R. J., Mayo G., Price P., FitzGerald G. A. Suppression of thromboxane A2 but not of systemic prostacyclin by controlled-release aspirin. N Engl J Med. 1991 Oct 17;325(16):1137–1141. doi: 10.1056/NEJM199110173251605. [DOI] [PubMed] [Google Scholar]
  7. Dalen J. E. An apple a day or an aspirin a day? Arch Intern Med. 1991 Jun;151(6):1066–1069. [PubMed] [Google Scholar]
  8. Dalen J. E., Hirsh J. Antithrombotic therapy. Introduction. Chest. 1992 Oct;102(4 Suppl):303S–304S. [PubMed] [Google Scholar]
  9. Davies M. J., Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. 1984 May 3;310(18):1137–1140. doi: 10.1056/NEJM198405033101801. [DOI] [PubMed] [Google Scholar]
  10. Dunn M., Alexander J., de Silva R., Hildner F. Antithrombotic therapy in atrial fibrillation. Chest. 1989 Feb;95(2 Suppl):118S–127S. doi: 10.1378/chest.95.2_supplement.118s. [DOI] [PubMed] [Google Scholar]
  11. Dyken M. L., Barnett H. J., Easton J. D., Fields W. S., Fuster V., Hachinski V., Norris J. W., Sherman D. G. Low-dose aspirin and stroke. "It ain't necessarily so". Stroke. 1992 Oct;23(10):1395–1399. doi: 10.1161/01.str.23.10.1395. [DOI] [PubMed] [Google Scholar]
  12. FitzGerald G. A. Dipyridamole. N Engl J Med. 1987 May 14;316(20):1247–1257. doi: 10.1056/NEJM198705143162005. [DOI] [PubMed] [Google Scholar]
  13. FitzGerald G. A. Ticlopidine in unstable angina. A more expensive aspirin? Circulation. 1990 Jul;82(1):296–298. doi: 10.1161/01.cir.82.1.296. [DOI] [PubMed] [Google Scholar]
  14. Fitzgerald D. J., Fitzgerald G. A. Role of thrombin and thromboxane A2 in reocclusion following coronary thrombolysis with tissue-type plasminogen activator. Proc Natl Acad Sci U S A. 1989 Oct;86(19):7585–7589. doi: 10.1073/pnas.86.19.7585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Fuster V., Adams P. C., Badimon J. J., Chesebro J. H. Platelet-inhibitor drugs' role in coronary artery disease. Prog Cardiovasc Dis. 1987 Mar-Apr;29(5):325–346. doi: 10.1016/0033-0620(87)90001-6. [DOI] [PubMed] [Google Scholar]
  16. Fuster V., Chesebro J. H. Role of platelets and platelet inhibitors in aortocoronary artery vein-graft disease. Circulation. 1986 Feb;73(2):227–232. doi: 10.1161/01.cir.73.2.227. [DOI] [PubMed] [Google Scholar]
  17. Fuster V., Dyken M. L., Vokonas P. S., Hennekens C. Aspirin as a therapeutic agent in cardiovascular disease. Special Writing Group. Circulation. 1993 Feb;87(2):659–675. doi: 10.1161/01.cir.87.2.659. [DOI] [PubMed] [Google Scholar]
  18. Goldman S., Copeland J., Moritz T., Henderson W., Zadina K., Ovitt T., Doherty J., Read R., Chesler E., Sako Y. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: results of a Veterans Administration Cooperative Study. Circulation. 1988 Jun;77(6):1324–1332. doi: 10.1161/01.cir.77.6.1324. [DOI] [PubMed] [Google Scholar]
  19. Goldman S., Copeland J., Moritz T., Henderson W., Zadina K., Ovitt T., Doherty J., Read R., Chesler E., Sako Y. Saphenous vein graft patency 1 year after coronary artery bypass surgery and effects of antiplatelet therapy. Results of a Veterans Administration Cooperative Study. Circulation. 1989 Nov;80(5):1190–1197. doi: 10.1161/01.cir.80.5.1190. [DOI] [PubMed] [Google Scholar]
  20. Goldman S., Copeland J., Moritz T., Henderson W., Zadina K., Ovitt T., Kern K. B., Sethi G., Sharma G. V., Khuri S. Internal mammary artery and saphenous vein graft patency. Effects of aspirin. Circulation. 1990 Nov;82(5 Suppl):IV237–IV242. [PubMed] [Google Scholar]
  21. Goldman S., Copeland J., Moritz T., Henderson W., Zadina K., Ovitt T., Kern K. B., Sethi G., Sharma G. V., Khuri S. Starting aspirin therapy after operation. Effects on early graft patency. Department of Veterans Affairs Cooperative Study Group. Circulation. 1991 Aug;84(2):520–526. doi: 10.1161/01.cir.84.2.520. [DOI] [PubMed] [Google Scholar]
  22. Harker L. A. Clinical trials evaluating platelet-modifying drugs in patients with atherosclerotic cardiovascular disease and thrombosis. Circulation. 1986 Feb;73(2):206–223. doi: 10.1161/01.cir.73.2.206. [DOI] [PubMed] [Google Scholar]
  23. Harrison D. G., Ferguson D. W., Collins S. M., Skorton D. J., Ericksen E. E., Kioschos J. M., Marcus M. L., White C. W. Rethrombosis after reperfusion with streptokinase: importance of geometry of residual lesions. Circulation. 1984 May;69(5):991–999. doi: 10.1161/01.cir.69.5.991. [DOI] [PubMed] [Google Scholar]
  24. Henderson W. G., Goldman S., Copeland J. G., Moritz T. E., Harker L. A. Antiplatelet or anticoagulant therapy after coronary artery bypass surgery. A meta-analysis of clinical trials. Ann Intern Med. 1989 Nov 1;111(9):743–750. doi: 10.7326/0003-4819-111-9-743. [DOI] [PubMed] [Google Scholar]
  25. Hennekens C. H., Buring J. E., Sandercock P., Collins R., Peto R. Aspirin and other antiplatelet agents in the secondary and primary prevention of cardiovascular disease. Circulation. 1989 Oct;80(4):749–756. doi: 10.1161/01.cir.80.4.749. [DOI] [PubMed] [Google Scholar]
  26. Hirsh J., Fuster V., Salzman E. Dose antiplatelet agents; the relationship among side effects, and antithrombotic effectiveness. Chest. 1986 Feb;89(2 Suppl):4S–10S. doi: 10.1378/chest.89.2_supplement.4s. [DOI] [PubMed] [Google Scholar]
  27. Hirsh J. Oral anticoagulant therapy. Urgent need for standardization. Circulation. 1992 Oct;86(4):1332–1335. doi: 10.1161/01.cir.86.4.1332. [DOI] [PubMed] [Google Scholar]
  28. Hsia J., Hamilton W. P., Kleiman N., Roberts R., Chaitman B. R., Ross A. M. A comparison between heparin and low-dose aspirin as adjunctive therapy with tissue plasminogen activator for acute myocardial infarction. Heparin-Aspirin Reperfusion Trial (HART) Investigators. N Engl J Med. 1990 Nov 22;323(21):1433–1437. doi: 10.1056/NEJM199011223232101. [DOI] [PubMed] [Google Scholar]
  29. Ip J. H., Stein B., Fuster V., Badimon L. Antithrombotic therapy in cardiovascular diseases. Future directions based on pathogenesis and risk. Ann N Y Acad Sci. 1991;614:289–311. doi: 10.1111/j.1749-6632.1991.tb43711.x. [DOI] [PubMed] [Google Scholar]
  30. Israel D. H., Fuster V., Chesebro J. H., Badimon L. Antithrombotic therapy for coronary artery disease and valvular heart disease. Baillieres Clin Haematol. 1990 Jul;3(3):705–743. doi: 10.1016/s0950-3536(05)80026-5. [DOI] [PubMed] [Google Scholar]
  31. Juul-Möller S., Edvardsson N., Jahnmatz B., Rosén A., Sørensen S., Omblus R. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. The Swedish Angina Pectoris Aspirin Trial (SAPAT) Group. Lancet. 1992 Dec 12;340(8833):1421–1425. doi: 10.1016/0140-6736(92)92619-q. [DOI] [PubMed] [Google Scholar]
  32. Kannel W. B., Feinleib M. Natural history of angina pectoris in the Framingham study. Prognosis and survival. Am J Cardiol. 1972 Feb;29(2):154–163. doi: 10.1016/0002-9149(72)90624-8. [DOI] [PubMed] [Google Scholar]
  33. Kelton J. G., Carter C. J., Santos A., Hirsh J. Sex related differences in platelet function: the effect of aspirin. Blood. 1982 Mar;59(3):625–627. [PubMed] [Google Scholar]
  34. Lekstrom J. A., Bell W. R. Aspirin in the prevention of thrombosis. Medicine (Baltimore) 1991 May;70(3):161–178. doi: 10.1097/00005792-199105000-00001. [DOI] [PubMed] [Google Scholar]
  35. Levine H. J., Pauker S. G., Salzman E. W. Antithrombotic therapy in valvular heart disease. Chest. 1989 Feb;95(2 Suppl):98S–106S. doi: 10.1378/chest.95.2_supplement.98s. [DOI] [PubMed] [Google Scholar]
  36. Lewis H. D., Jr, Davis J. W., Archibald D. G., Steinke W. E., Smitherman T. C., Doherty J. E., 3rd, Schnaper H. W., LeWinter M. M., Linares E., Pouget J. M. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N Engl J Med. 1983 Aug 18;309(7):396–403. doi: 10.1056/NEJM198308183090703. [DOI] [PubMed] [Google Scholar]
  37. Manson J. E., Grobbee D. E., Stampfer M. J., Taylor J. O., Goldhaber S. Z., Gaziano J. M., Ridker P. M., Buring J. E., Hennekens C. H. Aspirin in the primary prevention of angina pectoris in a randomized trial of United States physicians. Am J Med. 1990 Dec;89(6):772–776. doi: 10.1016/0002-9343(90)90220-8. [DOI] [PubMed] [Google Scholar]
  38. Manson J. E., Stampfer M. J., Colditz G. A., Willett W. C., Rosner B., Speizer F. E., Hennekens C. H. A prospective study of aspirin use and primary prevention of cardiovascular disease in women. JAMA. 1991 Jul 24;266(4):521–527. [PubMed] [Google Scholar]
  39. Marler J. R., Price T. R., Clark G. L., Muller J. E., Robertson T., Mohr J. P., Hier D. B., Wolf P. A., Caplan L. R., Foulkes M. A. Morning increase in onset of ischemic stroke. Stroke. 1989 Apr;20(4):473–476. doi: 10.1161/01.str.20.4.473. [DOI] [PubMed] [Google Scholar]
  40. Martin J. F., Bath P. M., Burr M. L. Influence of platelet size on outcome after myocardial infarction. Lancet. 1991 Dec 7;338(8780):1409–1411. doi: 10.1016/0140-6736(91)92719-i. [DOI] [PubMed] [Google Scholar]
  41. McCall N. T., Tofler G. H., Schafer A. I., Williams G. H., Muller J. E. The effect of enteric-coated aspirin on the morning increase in platelet activity. Am Heart J. 1991 May;121(5):1382–1388. doi: 10.1016/0002-8703(91)90142-5. [DOI] [PubMed] [Google Scholar]
  42. Miller K. P., Frishman W. H. Platelets and antiplatelet therapy in ischemic heart disease. Med Clin North Am. 1988 Jan;72(1):117–184. doi: 10.1016/s0025-7125(16)30788-x. [DOI] [PubMed] [Google Scholar]
  43. Mills J. A. Aspirin, the ageless remedy? N Engl J Med. 1991 Oct 31;325(18):1303–1304. doi: 10.1056/NEJM199110313251808. [DOI] [PubMed] [Google Scholar]
  44. Moncada S., Vane J. R. Arachidonic acid metabolites and the interactions between platelets and blood-vessel walls. N Engl J Med. 1979 May 17;300(20):1142–1147. doi: 10.1056/NEJM197905173002006. [DOI] [PubMed] [Google Scholar]
  45. Montalescot G., Drobinski G., Maclouf J., Maillet F., Salloum J., Ankri A., Kazatchkine M., Eugène L., Thomas D., Grosgogeat Y. Evaluation of thromboxane production and complement activation during myocardial ischemia in patients with angina pectoris. Circulation. 1991 Nov;84(5):2054–2062. doi: 10.1161/01.cir.84.5.2054. [DOI] [PubMed] [Google Scholar]
  46. Neri Serneri G. G., Gensini G. F., Poggesi L., Trotta F., Modesti P. A., Boddi M., Ieri A., Margheri M., Casolo G. C., Bini M. Effect of heparin, aspirin, or alteplase in reduction of myocardial ischaemia in refractory unstable angina. Lancet. 1990 Mar 17;335(8690):615–618. doi: 10.1016/0140-6736(90)90407-v. [DOI] [PubMed] [Google Scholar]
  47. Nyman I., Larsson H., Wallentin L. Prevention of serious cardiac events by low-dose aspirin in patients with silent myocardial ischaemia. The Research Group on Instability in Coronary Artery Disease in Southeast Sweden. Lancet. 1992 Aug 29;340(8818):497–501. doi: 10.1016/0140-6736(92)91706-e. [DOI] [PubMed] [Google Scholar]
  48. Oczkowski W. J., Turpie A. G. Antithrombotic treatment of cerebrovascular disease. Baillieres Clin Haematol. 1990 Jul;3(3):781–813. doi: 10.1016/s0950-3536(05)80028-9. [DOI] [PubMed] [Google Scholar]
  49. Page Y., Tardy B., Zeni F., Comtet C., Terrana R., Bertrand J. C. Thrombotic thrombocytopenic purpura related to ticlopidine. Lancet. 1991 Mar 30;337(8744):774–776. doi: 10.1016/0140-6736(91)91383-6. [DOI] [PubMed] [Google Scholar]
  50. Peto R., Gray R., Collins R., Wheatley K., Hennekens C., Jamrozik K., Warlow C., Hafner B., Thompson E., Norton S. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J (Clin Res Ed) 1988 Jan 30;296(6618):313–316. doi: 10.1136/bmj.296.6618.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Reilly I. A., FitzGerald G. A. Aspirin in cardiovascular disease. Drugs. 1988 Feb;35(2):154–176. doi: 10.2165/00003495-198835020-00005. [DOI] [PubMed] [Google Scholar]
  52. Resnekov L., Chediak J., Hirsh J., Lewis H. D., Jr Antithrombotic agents in coronary artery disease. Chest. 1989 Feb;95(2 Suppl):52S–72S. doi: 10.1378/chest.95.2_supplement.52s. [DOI] [PubMed] [Google Scholar]
  53. Ridker P. M., Manson J. E., Gaziano J. M., Buring J. E., Hennekens C. H. Low-dose aspirin therapy for chronic stable angina. A randomized, placebo-controlled clinical trial. Ann Intern Med. 1991 May 15;114(10):835–839. doi: 10.7326/0003-4819-114-10-835. [DOI] [PubMed] [Google Scholar]
  54. Rosen F. S. The acquired immunodeficiency syndrome (AIDS). J Clin Invest. 1985 Jan;75(1):1–3. doi: 10.1172/JCI111659. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Saltiel E., Ward A. Ticlopidine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in platelet-dependent disease states. Drugs. 1987 Aug;34(2):222–262. doi: 10.2165/00003495-198734020-00003. [DOI] [PubMed] [Google Scholar]
  56. Sanz G., Pajarón A., Alegría E., Coello I., Cardona M., Fournier J. A., Gómez-Recio M., Ruano J., Hidalgo R., Medina A. Prevention of early aortocoronary bypass occlusion by low-dose aspirin and dipyridamole. Grupo Español para el Seguimiento del Injerto Coronario (GESIC) Circulation. 1990 Sep;82(3):765–773. doi: 10.1161/01.cir.82.3.765. [DOI] [PubMed] [Google Scholar]
  57. Sethi G. K., Copeland J. G., Goldman S., Moritz T., Zadina K., Henderson W. G. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. Department of Veterans Affairs Cooperative Study on Antiplatelet Therapy. J Am Coll Cardiol. 1990 Jan;15(1):15–20. doi: 10.1016/0735-1097(90)90168-o. [DOI] [PubMed] [Google Scholar]
  58. Sherman C. T., Litvack F., Grundfest W., Lee M., Hickey A., Chaux A., Kass R., Blanche C., Matloff J., Morgenstern L. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med. 1986 Oct 9;315(15):913–919. doi: 10.1056/NEJM198610093151501. [DOI] [PubMed] [Google Scholar]
  59. Sherman D. G., Dyken M. L., Fisher M., Harrison M. J., Hart R. G. Antithrombotic therapy for cerebrovascular disorders. Chest. 1989 Feb;95(2 Suppl):140S–155S. doi: 10.1378/chest.95.2_supplement.140s. [DOI] [PubMed] [Google Scholar]
  60. Smith P., Arnesen H., Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction. N Engl J Med. 1990 Jul 19;323(3):147–152. doi: 10.1056/NEJM199007193230302. [DOI] [PubMed] [Google Scholar]
  61. Spranger M., Aspey B. S., Harrison M. J. Sex difference in antithrombotic effect of aspirin. Stroke. 1989 Jan;20(1):34–37. doi: 10.1161/01.str.20.1.34. [DOI] [PubMed] [Google Scholar]
  62. Steele P., Battock D., Pappas G., Genton E. Correlation of platelet survival time with occlusion of saphenous vein aorto-coronary bypass grafts. Circulation. 1976 Apr;53(4):685–687. doi: 10.1161/01.cir.53.4.685. [DOI] [PubMed] [Google Scholar]
  63. Stein B., Fuster V., Halperin J. L., Chesebro J. H. Antithrombotic therapy in cardiac disease. An emerging approach based on pathogenesis and risk. Circulation. 1989 Dec;80(6):1501–1513. doi: 10.1161/01.cir.80.6.1501. [DOI] [PubMed] [Google Scholar]
  64. Stein B., Fuster V., Israel D. H., Cohen M., Badimon L., Badimon J. J., Chesebro J. H. Platelet inhibitor agents in cardiovascular disease: an update. J Am Coll Cardiol. 1989 Oct;14(4):813–836. doi: 10.1016/0735-1097(89)90453-1. [DOI] [PubMed] [Google Scholar]
  65. Stein P. D., Kantrowitz A. Antithrombotic therapy in mechanical and biological prosthetic heart valves and saphenous vein bypass grafts. Chest. 1989 Feb;95(2 Suppl):107S–117S. doi: 10.1378/chest.95.2_supplement.107s. [DOI] [PubMed] [Google Scholar]
  66. Thaulow E., Erikssen J., Sandvik L., Stormorken H., Cohn P. F. Blood platelet count and function are related to total and cardiovascular death in apparently healthy men. Circulation. 1991 Aug;84(2):613–617. doi: 10.1161/01.cir.84.2.613. [DOI] [PubMed] [Google Scholar]
  67. Théroux P., Ouimet H., McCans J., Latour J. G., Joly P., Lévy G., Pelletier E., Juneau M., Stasiak J., deGuise P. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988 Oct 27;319(17):1105–1111. doi: 10.1056/NEJM198810273191701. [DOI] [PubMed] [Google Scholar]
  68. Tofler G. H., Brezinski D., Schafer A. I., Czeisler C. A., Rutherford J. D., Willich S. N., Gleason R. E., Williams G. H., Muller J. E. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med. 1987 Jun 11;316(24):1514–1518. doi: 10.1056/NEJM198706113162405. [DOI] [PubMed] [Google Scholar]
  69. Trip M. D., Cats V. M., van Capelle F. J., Vreeken J. Platelet hyperreactivity and prognosis in survivors of myocardial infarction. N Engl J Med. 1990 May 31;322(22):1549–1554. doi: 10.1056/NEJM199005313222201. [DOI] [PubMed] [Google Scholar]
  70. Turpie A. G. Clinical studies: evidence for intervention with specific antiplatelet drugs in arterial thromboembolism. Semin Thromb Hemost. 1988 Jan;14(1):41–49. doi: 10.1055/s-2007-1002754. [DOI] [PubMed] [Google Scholar]
  71. Van de Werf F., Arnold A. E. Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction. BMJ. 1988 Nov 26;297(6660):1374–1379. doi: 10.1136/bmj.297.6660.1374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Vanhoutte P. M., Shimokawa H. Endothelium-derived relaxing factor and coronary vasospasm. Circulation. 1989 Jul;80(1):1–9. doi: 10.1161/01.cir.80.1.1. [DOI] [PubMed] [Google Scholar]
  73. Wallentin L. C. Aspirin (75 mg/day) after an episode of unstable coronary artery disease: long-term effects on the risk for myocardial infarction, occurrence of severe angina and the need for revascularization. Research Group on Instability in Coronary Artery Disease in Southeast Sweden. J Am Coll Cardiol. 1991 Dec;18(7):1587–1593. doi: 10.1016/0735-1097(91)90489-v. [DOI] [PubMed] [Google Scholar]
  74. Warlow C. Ticlopidine, a new antithrombotic drug: but is it better than aspirin for longterm use? J Neurol Neurosurg Psychiatry. 1990 Mar;53(3):185–187. doi: 10.1136/jnnp.53.3.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Wilhelmsen L. Thrombocytes and coronary heart disease. Circulation. 1991 Aug;84(2):936–938. doi: 10.1161/01.cir.84.2.936. [DOI] [PubMed] [Google Scholar]
  76. Yusuf S., Wittes J., Friedman L. Overview of results of randomized clinical trials in heart disease. II. Unstable angina, heart failure, primary prevention with aspirin, and risk factor modification. JAMA. 1988 Oct 21;260(15):2259–2263. [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES