Key result
Methotrexate and TNF inhibitors show cardioprotection in arthritis, while JAK inhibitors and NSAIDs raise CV risk.
Why the study?
The optimal choice, initiation, combination, and duration of antiplatelet therapy in ACS to maximize effectiveness and minimize bleeding risk remains an issue of intense scientific interest.
May support preferring methotrexate or TNF inhibitors over JAK inhibitors or NSAIDs in inflammatory joint diseases; leaves open prospective CV outcome trials.
BACKGROUND: Acute coronary syndromes (ACS) represent the final step in the chronic process of atherothrombotic coronary disease which begins early in life as thickening of intima layer and progresses to fibroatheroma and fibrocalcific lesions with vulnerable characteristics. METHODS: As abrupt occlusion in the settings of ACS happens due to platelet aggregation and mobilization antiplatelet treatment has gained significant interest especially in the settings of primary percutaneous intervention and the aim of this review article is to understand the current evidence justifying the use and combination of different antiplatelet agents. RESULTS: Beyond aspirin, several antiplatelet agents (ADP receptor inhibitors, Glycoprotein IIb/IIIa inhibitors and varopaxar) are used in combination to effectively inhibit platelet activity. However the best choice, initiation, combination and duration of antithrombotic treatment, in order to maximize the effectiveness of therapy and reduce the hazard of bleeding, depends on the clinical setting and patient specific characteristics and is an issue of intense scientific interest. CONCLUSION: Early and potent platelet inhibition with safety reassurance can be achieved by a combination of antiplatelet agents and is essential for the management of ACS. Therefore in this review article we focus on the current evidence regarding rational, safety and effectiveness of current antiplatelet approaches in acute coronary syndromes.
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Oikonomou et al. (2016) conducted a review in Inflammatory autoimmune and immune-mediated joint diseases (Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis). Disease-modifying antirheumatic drugs (DMARDs) was evaluated. Methotrexate and TNF inhibitors demonstrate the strongest evidence for cardioprotection in inflammatory joint diseases, whereas JAK inhibitors and NSAIDs are associated with increased cardiovascular and thrombotic risks.
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