Current antiplatelet options for NSTE-ACS patients
QJM: An International Journal of Medicine, 05/04/2012
Cayla G et al. – The literature suggests several differences between ticagrelor and prasugrel that should allow clinicians to better tailor treatment to the patient. Head–to–head comparisons are now needed to compare directly the risks and benefits of ticagrelor and prasugrel in Non–ST elevation (NSTE)–acute coronary syndrome (ACS).
- Non–ST elevation (NSTE) myocardial infarction and unstable angina are the most common clinical presentations of acute coronary syndrome (ACS).
- Platelet activation is central to the pathogenesis of NSTE–ACS and consensus guidelines that advocate early revascularization supported by intensive antiplatelet therapy.
- This review examines the drugs used concurrently with aspirin as dual antiplatelet therapy in the NSTE–ACS setting.
- Clopidogrel represented an important therapeutic advance.
- However, variations in platelet response and a relatively slow onset of action compromise outcomes with clopidogrel.
- Evidence reviewed in this article shows that in NSTE–ACS patients, ticagrelor and prasugrel are more effective than clopidogrel and are relatively well tolerated, with an acceptable and manageable bleeding risk.