Dual Antiplatelet Therapy in Coronary Artery Disease
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REVIEW
Dual Antiplatelet Therapy in Coronary Artery Disease Raghav Sharma . Prathap Kumar . S. P. Prashanth . Yogesh Belagali
Received: July 15, 2020 Ó The Author(s) 2020
ABSTRACT 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 Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12753119. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40119020-00197-0) contains supplementary material, which is available to authorized users. R. Sharma Interventional Cardiologist, Meditrina Hospital Civil Hospital, Ambala Cantt, Haryana, India P. Kumar Interventional Cardiologist, Meditrina Hospital, Ayoor road, Ayathil, Kollam, Kerala, India S. P. Prashanth Y. Belagali (&) Medical Affairs Division, AstraZeneca, Rachenahalli, Bangalore, India e-mail: [email protected]
Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE DAPT) scores are tools to support decision-making in deciding duration of dual antiplatelet therapy.
Keywords: Clopidogrel; Coronary artery disease; Dual antiplatelet therapy; Prasugrel; Switching between antiplatelets; Ticagrelor Key Summary Points 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 PRECISE DAPT scores are tools to support decision-making in deciding duration of dual antiplatelet therapy.
Cardiol Ther
INTRODUCTION
Table 1 Pharmacological properties of currently used antiplatelets
Coronary artery disease (CAD) and ACS together account for approximately 7 million deaths each year [1]. Ischemic heart disease (IHD) is the single greatest cause of mortality and loss of disability adjusted life years (DALYs) worldwide, which accounts for roughly 7 million deaths and 129 million DALYs annually. IHD and acute coronary syndrome (ACS) are the leading causes of death, on average, at younger ages and at economically productive ages in low- and
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