Antiplatelet therapy is recommended over anticoagulants for the secondary prevention of vascular death in patients with noncardioembolic ischemic stroke or transient ischemic attack based upon the 2006 American Heart Association/American Stroke Association guidelines for the prevention of stroke and the National Stroke Association guidelines for the management of transient ischemic attack. Aspirin is commonly used as a cornerstone antiplatelet agent considering its mild but definite prevention benefit and low costs. Other antiplatelet strategies that are currently recommended include extended-release dipyridamole plus low-dose aspirin (Aggrenox((R)), Asasantin((R))) and clopidogrel. In this brief review, we evaluate the cost-effectiveness of antiplatelet agents for secondary stroke prevention to better understand the socioeconomical value of the recommended agents.
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http://dx.doi.org/10.1586/14737167.7.4.357 | DOI Listing |
Eur Heart J Cardiovasc Pharmacother
November 2024
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Aims: A genotype-guided P2Y12-inhibitor de-escalation strategy, switching acute coronary syndrome (ACS) patients without a CYP2C19 loss-of-function allele from ticagrelor or prasugrel to clopidogrel, has shown to reduce bleeding risk without affecting effectivity of therapy by increasing ischemic risk. We estimated the cost-effectiveness of this personalized approach compared to standard dual antiplatelet therapy (DAPT; aspirin plus ticagrelor/prasugrel) in the Netherlands.
Methods And Results: We developed a one-year decision tree based on results of the FORCE-ACS registry, comparing a cohort of ACS patients who underwent genotyping with a cohort of ACS patients treated with standard DAPT.
Health Technol Assess
September 2024
Bristol TAG, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Neurosurg Rev
August 2024
Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Dual antiplatelet therapy (DAPT) use is the standard of practice after flow diversion (FD) for intracranial aneurysms (IAs). Yet, no consensus exists in the literature regarding the optimal regimen. Certain institutions utilize various platelet function testing (PFT) to assess patient responsiveness to DAPT.
View Article and Find Full Text PDFEur Phys J E Soft Matter
August 2024
Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, 11461, Saudi Arabia.
J Am Heart Assoc
April 2024
Department of Neurology, Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute, Weill Cornell Medicine New York NY.
Background: Rates of dual antiplatelet therapy (DAPT) after high-risk transient ischemic attack or minor ischemic stroke (TIAMIS) are suboptimal. We performed a cost-effectiveness analysis to characterize the parameters of a quality improvement (QI) intervention designed to increase DAPT use after TIAMIS.
Methods And Results: We constructed a decision tree model that compared current national rates of DAPT use after TIAMIS with rates after implementing a theoretical QI intervention designed to increase appropriate DAPT use.
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