Antiplatelet therapy for secondary prevention of coronary artery disease

Area of Science:

• Cardiology
• Pharmacology

Background:

• Secondary prevention of coronary artery disease (CAD) relies on antiplatelet therapy.
• Key agents include aspirin and P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor).

Purpose of the Study:

• To review the choice and duration of antiplatelet therapy for secondary CAD prevention.
• To compare the efficacy and safety of different antiplatelet agents in various clinical scenarios.

Main Methods:

• Literature review of clinical trials and guidelines.
• Comparative analysis of antiplatelet agents in stable CAD, acute coronary syndrome, and post-percutaneous coronary intervention.

Main Results:

• Aspirin is foundational; clopidogrel is used with aspirin in stable CAD post-intervention.
• Prasugrel and ticagrelor improve outcomes in acute coronary syndrome but increase bleeding risk versus clopidogrel.
• Prasugrel is effective in ST-elevation myocardial infarction and in diabetic patients. Ticagrelor reduces mortality without increasing CABG bleeding.
• Dual antiplatelet therapy duration: minimum 1 year for acute coronary syndrome; up to 6 months for stable CAD with new-generation drug-eluting stents.

Conclusions:

• Antiplatelet therapy selection and duration must be individualized based on clinical presentation and treatment.
• Newer P2Y12 inhibitors offer advantages in specific high-risk populations but require careful bleeding risk assessment.
• Current evidence supports specific durations for dual antiplatelet therapy to optimize net clinical benefit.