Advances in antiplatelet treatment for acute coronary syndromes

Context: 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. Data Sources: CURE, TRITON-TIMI 38 and PLATO trials. Study Selection: Large randomized placebo controlled trials of dual antiplatelet therapy in acute coronary syndromes. Data Extraction: From original trials. Results and 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.