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Dual antiplatelet therapy in coronary artery disease: A case-based approach
Cleveland Clinic Journal of Medicine, 11/03/09

Raymond C et al. – Current guidelines support dual antiplatelet therapy with aspirin and clopidogrel (Plavix) in a number of clinical scenarios, ie, in ST–segment–elevation myocardial infarction (MI), non–ST–elevation MI, and percutaneous coronary intervention. The guidelines are based on strong evidence from several large randomized clinical trials over the last 10 years. The authors present several cases to show how to put this evidence into day–to–day clinical practice.

Dual antiplatelet therapy is recommended after ST–elevation MI or non–ST–elevation acute coronary syndromes, with aspirin indefinitely and clopidogrel for up to 1 year.
Dual antiplatelet therapy is recommended for at least 1 month after placement of a bare–metal stent and for at least 1 year (or possibly indefinitely) after placement of a drug–eluting stent.
There is no compelling indication for clopidogrel in patients with chronic coronary artery disease.
Compared with clopidogrel, prasugrel (Effient) is associated with lower rates of MI, urgent target–vessel revascularization, and in–stent thrombosis, but at the cost of a higher risk of major bleeding.

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