Unbound MEDLINE

Current antiplatelet options for NSTE-ACS patients.

Abstract

Non-ST elevation (NSTE) myocardial infarction and unstable angina are the most common clinical presentations of acute coronary syndrome (ACS). Platelet activation is central to the pathogenesis of NSTE-ACS and consensus guidelines that advocate early revascularization supported by intensive antiplatelet therapy. This review examines the drugs used concurrently with aspirin as dual antiplatelet therapy in the NSTE-ACS setting. Clopidogrel represented an important therapeutic advance. However, variations in platelet response and a relatively slow onset of action compromise outcomes with clopidogrel. Evidence reviewed in this article shows that in NSTE-ACS patients, ticagrelor and prasugrel are more effective than clopidogrel and are relatively well tolerated, with an acceptable and manageable bleeding risk. The literature suggests several differences between ticagrelor and prasugrel that should allow clinicians to better tailor treatment to the patient. Head-to-head comparisons are now needed to compare directly the risks and benefits of ticagrelor and prasugrel in NSTE-ACS. Further studies also need to address other outstanding issues such as the benefits and risks of prasugrel pre-treatment and to stratify efficacy and tolerability according to diabetes mellitus (DM) and other co-morbidities. In the meantime, the issues discussed in this review should enhance clinicians' ability to optimize and individualize NSTE-ACS treatment, thereby further reducing the morbidity and mortality associated with this common cardiovascular condition.

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  • Publisher Full Text
  • Authors

    Cayla G, Silvain J, O'Connor SA, Collet JP, Montalescot G

    Institution

    Institut de Cardiologie, Bureau 236, Pitié-Salpêtrière University Hospital, 47-83, Bld de l'Hôpital, 75013 Paris, France.

    Source

    QJM : monthly journal of the Association of Physicians 105:10 2012 Oct pg 935-48

    MeSH

    Acute Coronary Syndrome
    Adenosine
    Aspirin
    Biological Availability
    Comparative Effectiveness Research
    Drug Monitoring
    Drug Synergism
    Drug Therapy, Combination
    Electrocardiography
    Humans
    Pharmacovigilance
    Piperazines
    Platelet Activation
    Platelet Aggregation Inhibitors
    Randomized Controlled Trials as Topic
    Receptors, Purinergic P2Y
    Risk Assessment
    Thiophenes
    Ticlopidine
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    22543683