Popular Cardiologist in Vidyaranyapura, Bangalore • Anti-platelet therapy Unless there is a contraindication (usually gastric intolerance but occasionally allergy) all patients with suspected angina should take aspirin.14 A daily dose of 75 mg is enough to cause irreversible cyclo-oxygenase inhibition of all the patient’s platelets. Recovery occurs only as platelets are replaced. This treatment causes significant reduction in platelet adhesiveness and reduces the risk of thrombosis within the coronary arteries following rupture of an atherosclerotic plaque. There is a definite improvement in mortality when aspirin is used after myocardial infarction and a probable improvement for patients with angina. The use of half an aspirin tablet (150 mg) is the cheapest approach to aspirin use, but 100 mg preparations in coated tablets and calendar packets are available. Patients unable to tolerate aspirin because of gastric side effects can often be treated with the combination of aspirin and a proton pump inhibitor. The relative risk of cerebral haemorrhage increases by 30% for patients taking aspirin but the absolute risk is less than 1 per 1000 patient years of treatment. For patients with aspirin allergy or intolerance, 75 mg of clopidogrel a day is usually a safer but expensive alternative. It is also associated with a small risk of gastrointestinal bleeding (1.99% versus 2.66% for aspirin over two years in the CAPRIE study). Combination (dual anti-platelet/aspirin and clopidogrel) treatment is not currently indicated for stable angina. Aspirin and clopidogrel resistance