Advances in antiplatelet treatment for acute coronary syndromes.
BACKGROUND
Recent publications of TRITON-TIMI (prasugrel) as well as PLATO (ticagrelor) have introduced new and potent antiplatelet agents, but at the same time have left clinicians with multiple choices without clear directions regarding the most appropriate use of these agents.


OBJECTIVE
1. To review the randomized controlled trial evidence examining the role of the three antiplatelet gents in acute coronary syndromes is presented. 2. To provide recommendations for the practicing physician for their optimal use in clinical practice.


METHODS
CURE, TRITON-TIMI 38 and PLATO trials.


METHODS
Selection Large randomized placebo controlled trials of dual antiplatelet therapy in acute coronary syndromes. Data Extraction From original trials.


CONCLUSIONS
Both prasugrel and ticagrelor are potent antiplatelet agents with improved ischaemic benefits in comparison with clopidogrel. The improved benefit, however, comes at the price of increased bleeding. As such, careful patient selection and balancing of benefit-risk is warranted to optimise their use in clinical practice.
Eshaghian
Shervin
S
Division of Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. kaul@cshs.org
Shah
Prediman K
PK
Kaul
Sanjay
S
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077144:Clopidogrel; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D016032:Randomized Controlled Trials as Topic; D013876:Thiophenes / Q000627:therapeutic use; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine