Prasugrel and ticagrelor improve net clinical outcomes by reducing ischemic events compared with clopidogrel in acute coronary syndrome, though at an increased risk of bleeding.
What is the optimal choice and duration of antiplatelet therapy for secondary prevention in patients with coronary artery disease?
This review summarizes the optimal choice and duration of antiplatelet therapy for secondary prevention in CAD, highlighting the benefits of newer P2Y12 inhibitors in ACS and shorter DAPT durations in stable CAD.
The choice and duration of antiplatelet therapy for secondary prevention of coronary artery disease (CAD) is determined by the clinical context and treatment strategy. Oral antiplatelet agents for secondary prevention include the cyclo-oxygenase-1 inhibitor aspirin, and the ADP dependent P2Y12 inhibitors clopidogrel, prasugrel and ticagrelor. Aspirin constitutes the cornerstone in secondary prevention of CAD and is complemented by clopidogrel in patients with stable CAD undergoing percutaneous coronary intervention. Among patients with acute coronary syndrome, prasugrel and ticagrelor improve net clinical outcome by reducing ischaemic adverse events at the expense of an increased risk of bleeding as compared with clopidogrel. Prasugrel appears particularly effective among patients with ST elevation myocardial infarction to reduce the risk of stent thrombosis compared with clopidogrel, and offered a greater net clinical benefit among patients with diabetes compared with patients without diabetes. Ticagrelor is associated with reduced mortality without increasing the rate of coronary artery bypass graft (CABG)-related bleeding as compared with clopidogrel. Dual antiplatelet therapy should be continued for a minimum of 1 year among patients with acute coronary syndrome irrespective of stent type; among patients with stable CAD treated with new generation drug-eluting stents, available data suggest no benefit to prolong antiplatelet treatment beyond 6 months.
Pilgrim et al. (2015) conducted a review in coronary artery disease. Antiplatelet therapy was evaluated. Prasugrel and ticagrelor improve net clinical outcomes by reducing ischemic events compared with clopidogrel in acute coronary syndrome, though at an increased risk of bleeding.