abstract
- Four drugs that inhibit platelet function have been evaluated for their antithrombotic effects in humans. These are aspirin, dipyridamole, hydroxychloroquine and sulphinpyrazone. Aspirin has been shown to reduce the number of transient ischemic attacks (TIA), stroke and death in patients with multiple TIA. The reduction in TIA was greatest in males who were normotensive and when there was an angiographically demonstrated lesion in the carotid artery that accounted for the symptoms. Aspirin reduced venous thrombosis and non-fatal and fatal pulmonary embolism in patients after surgery for fractured hip and after elective hip replacement. There is evidence that the prophylactic effect of aspirin may be greater in male patients. Aspirin reduced the frequency of arteriovenous shunt thrombosis. Aspirin abolished symptoms in patients with peripheral ischemia associated with thrombocytosis and spontaneous platelet aggregation. There is no conclusive evidence at the present time that aspirin is effective in patients with coronary artery artery disease. Dipyridamole in combination with oral anticoagulants is effective in reducing the frequency of systemic embolism in patients with prosthetic heart valve replacement but is ineffective in patients with transient cerebral ischemic attacks or for the prevention of venous thromboembolism. Hydroxychloroquine was effective in reducing postoperative venous thrombosis in patients undergoing general abdominothoracic surgery but the evidence that it was effective in patients undergoing orthopaedic surgery is inconclusive. Sulphinpyrazone may be effective in reducing the frequency of sudden cardiac deaths in patients in the first year after myocardial infarction when it is started within 25 to 35 days after the infarction. Sulphinpyrazone reduced the incidence of arteriovenous shunt thrombosis in patients undergoing chronic hemodialysis and in combination with anticoagulants, it reduced the frequency of recurrent venous thrombosis. There have been no large scale trials of platelet suppressant drugs in clinical cancer and successful treatment of thromboembolic disorders cannot be used to predict success in the treatment of malignant disease.