What is the secondary prevention of CVD?
In secondary prevention, the same strategies which are used in primary prevention are implemented but with the inclusion of further medications and therapies. Antiplatelet and anticoagulant therapies are two of the main drug treatments used in the secondary prevention, with aspirin currently being the most common and well known. However, the benefits and risks of using aspirin will be discussed in this essay along with comparing and contrasting other alternative therapies.
Platelets are key components of the normal haemostatic response to vascular injury. Through a process of adhesion, activation and aggregation they form a platelet plug, in a process known as primary haemostasis. This overlaps with the activation of the coagulation cascade resulting in fibrin formation, known as secondary haemostasis. The process of coagulation can be seen in Fig 1 below. However, in the presence of an abnormality such as an atherosclerotic plaque inappropriate platelet action can lead to thrombosis (5). If this occurs in an artery, arterial thrombosis may lead to a cardiovascular event such as an infarction. Antiplatelet drugs are particularly effective here as, in faster flowing vessels like these, thrombi are composed mainly of platelets and little fibrin. Therefore, antiplatelet drugs are vital in the prevention of this inappropriate platelet activation and producing a reduction in the risk of thrombosis.