title: Dual antiplatelet therapy -- management in general practice.
abstract: BACKGROUND
  Prasugrel and ticagrelor are two new antiplatelet agents being used in the management of acute coronary syndromes. The number of patients in the community managed on these medications is growing, and thus, it is essential that general practitioners have a good understanding of these agents and their evidence-based applications.
  
  
  OBJECTIVE
  The pharmacokinetic and pharmacodynamic properties of common and new antiplatelet agents will be reviewed, along with the evidence supporting their use. Safety and side effect profiles will be discussed, and some common general practice case scenarios presented.
  
  
  CONCLUSIONS
  Aspirin is still the mainstay of therapy in patients with acute coronary syndromes. The addition of clopidogrel, prasugrel or ticagrelor can reduce morbidity and mortality in selected patients. Patient factors including bleeding risk, renal function and time since coronary stent insertion must be reviewed before these agents are initiated and before making any changes to the medication regimen.
authors.affiliation: MBBS(Hons), MSpM, PhD, FRACP, FCSANZ, MBA, is Professor of Cardiology, Griffith University and Director of Cardiac Services/Cardiology, Gold Coast Health, Queensland.
authors.forename: Rohan
authors.initials: R
authors.lastname: Jayasinghe
authors.forename: Ryan
authors.initials: R
authors.lastname: Markham
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Adsett
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D001241:Aspirin / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000077144:Clopidogrel; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D000068799:Prasugrel Hydrochloride; D013876:Thiophenes / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin