| Keywords [eng] |
acute coronary syndrome, percutaneous coronary intervention, dual antiplatelet therapy, efficacy and safety, outcomes, clopidogrel, prasugrel, ticagrelor, CYP2C19 |
| Abstract [eng] |
Background: the mainstay treatment for patients with acute coronary syndromes (ACS) that undergo revascularization with percutaneous coronary intervention (PCI) is dual antiplatelet therapy (DAPT). This usually involves combining aspirin with an additional PY212 receptor inhibitor, either clopidogrel, prasugrel or ticagrelor. Despite numerous researches comparing the effectiveness and safety of these three drugs, their relative merits with regards to each other remain to be further elucidated. Objective: the aim of this research is to compare clopidogrel, prasugrel and ticagrelor in patients with ACS after undergoing PCI and subsequently shed more light on the debatable question of whether or not prasugrel and ticagrelor have the same benefits as clopidogrel. Methods: a narrative literature review was conducted. Electronic databases, including PubMed, ClinicalKey, Wiley Online Library, Vilnius university library, European Heart Journal and the American Heart Association Journal, and Google Scholar tool, were searched for eligible publications. Searching strategy was focused on clopidogrel vs. prasugrel vs. ticagrelor in patients with ACS after PCI. Selected resulted publications had to be published in the last 5 years. Current society guidelines in the field of cardiology were also included. Discussion: P2Y12 inhibitors are important antiplatelet drugs that together with aspirin constitute the so-called DAPT. DAPT is the cornerstone treatment of patients with ACS after PCI, aimed at reducing ischemic events, such as stent thrombosis (ST). Their usage however, is associated with a certain bleeding risk. The main P2Y12 inhibitors are clopidogrel, prasugrel and ticagrelor. Current guidelines recommend the more potent ticagrelor and prasugrel over clopidogrel, partly due to resistance of some patients to clopidogrel. Yet other groups of patients, like the elderly or East-Asian patients might not benefit from more potent drugs due to high bleeding risk. This risk-benefit trade-off is further complicated by the coronavirus disease 2019 (Covid-19) pandemic. Conclusion: benefits are highly dependent on bleeding/ischemia balance for each individual patient. While prasugrel and ticagrelor are beneficial in patients with high ischemic risk, clopidogrel, especially when guided by genetics or platelet function assays, could still be advantageous in other subset of patients, like the elderly, patients with increased bleeding risk, such as patients who are taking anticoagulants, and East-Asian patients. |
