The New Dual Antiplatelet Therapy Agents And Their Role in Acute Coronary Syndrome

Background: Prasugrel and ticagrelor are two novel antiplatelet agents, which have been subject to large randomized trials to compare their efficacy with clopidogrel for patients with acute coronary syndrome (ACS).Aim: To conduct a systematic review of prasugrel and ticagrelor as alternative therapy to clopidogrel in patients who present with ACS undergoing PCI.Methods: The articles cited in this paper were searched on PubMed, MEDLINE, and Plymouth University’s Metalib database. The search terms used included “dual antiplatelet therapy”, “prasugrel”, “ticagrelor”, and “clopidogrel resistance”. Discussion: The main indications for the use of prasugrel based on current understanding are patients presenting with acute STEMI referred for primary PCI, ACS patients with DM, or those who have a high risk of stent thrombosis. Ticagrelor, on the other hand, may provide optimal benefit for patients with NSTEMI treated with conservative or invasive therapy, those with previous TIA or stroke, advanced age, or small body surface. Conclusion: Prasugrel and ticagrelor have been shown to be adequate P2Y12 antiplatelet therapy alternatives to clopidogrel in the management of patients with ACS. While prasugrel and ticagrelor have both been shown to clinically improve platelet inhibition and significantly reduce the incidence of stent thrombosis compared with clopidogrel therapy, both increase the risk of a significant bleeding incident. Both ticagrelor and prasugrel have been shown to be appropriate and effective treatment alternatives for ACS patients who display clopidogrel treatment resistance or failure.