Dual antiplatelet therapy in patients with acute coronary syndrome: Rationale and treatment regimens with aspirin and clopidogrel

INTRODUCTION: Acute coronary syndrome (ACS) is a serious medical condition characterized by an abrupt reduction in blood flow to the heart, usually due to thrombus formation in the coronary arteries. Effective treatment of ACS is essential to prevent complications such as myocardial infarction and sudden death. Dual antiplatelet therapy (DAPT), which involves the combined use of aspirin and clopidogrel, has been shown to be an effective approach for the prevention of cardiovascular events in patients with ACS. OBJECTIVE: This study aims to explore the rationale and treatment regimens of DAPT in patients with ACS, using aspirin and clopidogrel, based on bibliographic references from renowned pharmacology textbooks. METHODOLOGY: A literature review was performed using the books "The Pharmacological Bases of Therapeutics by Goodman and Gilman" (Brunton et al., 2018), "Basic and Clinical Pharmacology" by Katzung and Vanderah (2017), "Clinical Pharmacology and Therapeutics" by Fuchs and Wannmacher (2015), among others. RESULTS: Aspirin, a nonsteroidal anti-inflammatory drug, acts by irreversibly inhibiting cyclooxygenase-1 (COX-1), decreasing the production of thromboxane A2, a potent inducer of platelet aggregation. Clopidogrel, an ADP receptor (P2Y12) inhibitor, prevents ADP-mediated platelet activation and aggregation. The combination of aspirin and clopidogrel results in a more robust inhibition of platelet function than the isolated use of each drug, significantly reducing the risk of adverse cardiovascular events in patients with ACS. CONCLUSIONS: ADT with aspirin and clopidogrel is a well-established therapeutic strategy for patients with ACS, providing additional protection against recurrent thrombotic events. A detailed understanding of the mechanisms of action and clinical benefits of these drugs is essential to optimize treatment and improve clinical outcomes.