The role of antiplatelet therapy in the secondary prevention of coronary artery disease.
OBJECTIVE
In this study, we review the evidence for both long-standing and newer oral antiplatelet agents as secondary prevention in coronary artery disease, and give our opinion on where each agent's treatment role lies.


RESULTS
Platelets play a pathological role in acute coronary syndromes and are therefore a major therapeutic target. The caveat to this is that their physiological haemostatic role means there must be a careful balance between preventing ischaemia and not promoting bleeding. In addition to accepted oral agents (aspirin and clopidogrel), more potent antiplatelet agents have recently become available (prasugrel and ticagrelor) at a cost of increased bleeding.


CONCLUSIONS
There is now a choice of three antiplatelet agents to be used in conjunction with aspirin for secondary prevention with dual antiplatelet therapy. Clinicians must now 'tailor' the correct therapy for each patient, depending on their presentation, clinical features and stage of risk.
Behan
Miles W
MW
Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia. milesbehan@hotmail.com
Chew
Derek P
DP
Aylward
Philip E
PE
D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000517:prevention & control; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000494:pharmacology; D058925:Receptors, Purinergic P2Y12 / Q000187:drug effects; D012307:Risk Factors; D055502:Secondary Prevention; D013876:Thiophenes / Q000627:therapeutic use; D013928:Thromboxane A2; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
C548576:P2RY12 protein, human; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D013876:Thiophenes; D013928:Thromboxane A2; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin