ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology
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Prominent features of management strategies in acute coronary syndromes with the new oral antiplatelet agents [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2013; 41(2): 166-171 | DOI: 10.5543/tkda.2013.42716

Prominent features of management strategies in acute coronary syndromes with the new oral antiplatelet agents

Rasim Enar
Department Of Cardiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

The novel oral P2Y12 inhibitors (prasugrel and ticagrelor) have been incorporated into the recently updated acute coronary syndrome (ACS) guidelines, as an adjunct antiplatelet treatment to aspirin. The studies involving the use of new oral antiplatelet agents that are more potent, predictable and faster platelet inhibitors than clopidogrel have demonstrated superiority with respect to the primary composite endpoint (cardiovascular death, non-lethal myocardial infarction, stroke) for both prasugrel and ticagrelor compared to clopidogrel. The subgroup analysis of the relevant studies showed that these new agents differ in their level of efficacy in different ACS patient subgroups: (1) Mortality was reduced with ticagrelor; (2) Ticagrelor is especially more effective in intermediate-and high-risk non-ST elevation ACS patients in whom early invasive strategy is selected; (3) Prasugrel should be especially preferred in patients with acute ST elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) after diagnostic angiography; and (4) Prasugrel is more effective in diabetic patients. While clopidogrel is recommended for ACS patients who are followed with a non-invasive strategy or who have not undergone percutaneous revascularization, it is the last line choice or an alternative to the P2Y12 inhibitor therapy for patients undergoing invasive strategy.

Keywords: Acute coronary syndrome/drug therapy, aspirin/therapeutic use; drug therapy, combination; hemorrhage/chemically induced; clopidogrel; myocardial infarction/epidemiology; prasugrel; ticagrelor; platelet aggregation inhibitors.

How to cite this article
Rasim Enar. Prominent features of management strategies in acute coronary syndromes with the new oral antiplatelet agents. Turk Kardiyol Dern Ars. 2013; 41(2): 166-171

Corresponding Author: Rasim Enar, Türkiye
Manuscript Language: Turkish


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