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Australian Journal of Pharmacy : March 2005
education counselling casebook Associate Professor Louis Roller BPharm, PhD, FPS, FACPP, Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University Dr Jenny Gowan PhD, FPS, FACPP, HMR Facilitator, Northern & North Eastern Division of General Practice, Melbourne, Consultant Pharmacist The patient at risk of platelet aggregation This article forms the third of three closely related topic areas (January: the patient with hyperlipidaemia; February: reduction of complications of diabetes) and should be considered as part of the overall risk factors for metabolic disorders EART, stroke and vascular diseases are Australia’s largest health problem, accounting for over 50,000 deaths in 2002 (37.6 per cent of all deaths) and affecting some 3.67 mil- lion in 2001. Over the last decade the prevalence of heart, stroke and vascular conditions rose by around 18.2 per cent. Over 1991–2002, death rates from heart, stroke and vascular disease fell by 36.3 per cent for men and 33.7 per cent for women. In 2000–2002, death rates from heart, stroke and vas- cular diseases in the most disadvantaged areas were 21.4 per cent higher than in the least disadvantaged. In the same period, death rates from heart, stroke and vascular diseases were 2.6 times as high for indigenous people as for others.1 Atherothrombosis is a global/systemic disease affecting cere- brovascular, coronary and peripheral beds and is the common pathological link between all major clinical manifestations of vascular disease: myocardial infarction, angina, ischaemic stroke, transient ischaemic attack (TIAs) and peripheral arterial disease. H People suffering from any one manifestation of atherothrom- bosis are at increased risk of suffering from future events in the same, or other vascular beds.2 Rupture or erosion of an atherosclerotic plaque exposes the thrombogenic core of the lesion and lead to adhesion and aggre- gation of platelets and thrombus formation. A large rupture typically results in the formation of a large thrombus that completely occludes the vessel, resulting in an acute vascular event. A smaller rupture may result in a mural thrombus that partially or transiently occludes the artery, caus- ing acute ischaemia and, in the long term, contributing to pro- gression of atherothrombosis.2 Platelets produce several inflam- matory modulators and play a significant role in atherothrom- botic development.3 Platelets and aggregation (see also Figure One) Intact endothelium is a potent thrombo-resistant surface due to the formation of locally acting platelet-inhibitory products, THE AUSTRALIAN JOURNAL OF PHARMACY VOL. 86 MARCH 2005 ? 203