Kelley Branch, MD: Antithrombotics in Primary, Secondary Prevention of Cardiovascular Disease

In a session at the American College of Physicians (ACP) Internal Medicine Meeting in Boston this past weekend, Kelley Branch, MD, MSc, professor in the division of cardiology at the University of Washington Heart Institute, reviewed approaches to the use of antithrombotics for the primary and secondary prevention of cardiovascular disease, something he noted experts are finding to be “a very confusing landscape.”

In an interview with HCPLive, Branch described the importance of making decisions based on patients’ risk, regardless of whether they are being treated for primary or secondary prevention. Specifically, in primary prevention, he noted risk plays a large role in whether or not clinicians should treat patients older than 70 years of age or younger than 40 years of age, saying “The guidelines are that for your patients less than 40, unless they're very high risk, routine therapy is not recommended. Similar for patients after 70, routine therapy with aspirin is not recommended for those patients.”

He described patients 50 - 59 years of age, or 40 - 69 years of age, depending on the guideline being used, as falling within the “golden zone” of consideration for aspirin therapy if they have an atherosclerotic cardiovascular disease (ASCVD) risk greater than 10% over the next 10 years, but was careful to note this must be discussed with patients to ensure they agree as well.

In secondary prevention, he pointed to the need to more aggressively treat patients with polyvascular disease, diabetes, renal dysfunction, and heart failure.

“For secondary prevention, with our improvement in stenting and with our improvement in other treatments such as statin and nonstatin therapies, we don't have to be treating patients as long as we had done previously with dual antiplatelet therapy,” Branch explained, adding that the idea of triple therapy with dual antiplatelet therapy plus an anticoagulant is “dead.”

He noted antiplatelet therapy is the basis for secondary prevention, mentioning that many clinicians are moving toward P2Y12, specifically clopidogrel. Regardless of the kind of antithrombotic medication, he emphasized “All those patients need to be on something.”

Branch has relevant disclosures with Bayer, Amgen, Hanmi, Janssen Pharmaceuticals, and Kestra.