This narrative review highlights the evolving landscape of oral antiplatelet therapy for secondary prevention after ACS, emphasizing individualized treatment duration and agent selection based on ischemic versus bleeding risks.
Individualized antiplatelet choice post-ACS balances ischemic versus bleeding risks; review leaves open optimal long-term regimens by patient profile.
Patients surviving an acute coronary syndrome (ACS) remain at increased risk of ischemic events long term. This paper reviews current evidence and guidelines for oral antiplatelet therapy for secondary prevention following ACS, with respect to decreased risk of ischemic events versus bleeding risk according to individual patient characteristics and risk factors. Specifically, data are reviewed from clinical studies of clopidogrel, prasugrel, ticagrelor and vorapaxar, as well as the results of systematic reviews and meta-analyses looking at the benefits and risks of oral antiplatelet therapy, and the relative merits of shorter versus longer duration of dual antiplatelet therapy, in different patient groups.
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Jeffrey S. Berger (2018) studied this question.
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