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Republished: Antiplatelet therapy for secondary prevention of coronary artery disease

Thomas Pilgrim1, Stephan Windecker1

  • 1Department of Cardiology, Bern University Hospital, Bern, Switzerland.

Postgraduate Medical Journal
|May 16, 2015
PubMed

Insights

Choosing antiplatelet therapy for coronary artery disease (CAD) secondary prevention depends on clinical context. Aspirin, clopidogrel, prasugrel, and ticagrelor are key agents, with specific durations recommended based on patient condition.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Secondary prevention of coronary artery disease (CAD) relies on antiplatelet therapy.
  • Key oral agents include aspirin (COX-1 inhibitor) and P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor).

Purpose of the Study:

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

Main Methods:

  • Literature review and synthesis of current evidence on antiplatelet therapy in CAD.
  • Comparison of clinical outcomes, including ischemic events and bleeding risk, associated with different antiplatelet agents.

Main Results:

  • Aspirin is foundational for CAD secondary prevention, often combined with clopidogrel for stable CAD post-percutaneous coronary intervention.
  • Prasugrel and ticagrelor offer improved net clinical outcomes in acute coronary syndrome (ACS) by reducing ischemic events, despite increased bleeding risk compared to clopidogrel.
  • Prasugrel shows particular benefit in ST-elevation myocardial infarction and in diabetic patients.
  • Ticagrelor is linked to reduced mortality without increased CABG-related bleeding versus clopidogrel.
  • Dual antiplatelet therapy (DAPT) is recommended for at least 1 year post-ACS.
  • For stable CAD with new-generation drug-eluting stents, DAPT beyond 6 months shows no additional benefit.

Conclusions:

  • The optimal antiplatelet strategy for CAD secondary prevention is context-dependent.
  • Duration of DAPT varies significantly between ACS and stable CAD patients.
  • Prasugrel and ticagrelor represent advancements over clopidogrel in specific high-risk ACS populations.

Keywords:
Coronary Artery Disease

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