Does dual antiplatelet therapy with ticagrelor or prasugrel reduce recurrent ischemic events compared to clopidogrel in patients with acute coronary syndrome?
This review summarizes current guidelines recommending DAPT for 1 year in ACS patients, with extended ticagrelor therapy for high-risk patients, guided by risk scores.
Acute coronary syndrome (ACS) is principally driven by platelet aggregation. Dual antiplatelet therapy (DAPT) has demonstrated a reduction in recurrent ischemic events. The newer antiplatelets ticagrelor and prasugrel have demonstrated superiority over clopidogrel. While prasugrel demonstrated benefit in patients scheduled for percutaneous intervention (PCI), benefits of ticagrelor were seen irrespective of the treatment strategy. Current guidelines recommend the use of DAPT for 1 year in all patients with ACS. Ticagrelor 60 mg is recommended for up to 3 years in high-risk patients. DAPT and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE DAPT) scores are tools to support decision-making in deciding duration of dual antiplatelet therapy.
Sharma et al. (2020) studied this question.