One of the “hottest” areas in cardiology today is antiplatelet therapy for acute coronary syndromes. There have been multiple new antiplatelet agents approved for clinical use over the past few years, and many large clinical trials are currently underway for others. A number of trials have had positive outcomes, thus advancing clinical medicine. But this vast array of information leaves even the best clinician confused about which agent is best for what type of patient. Should we stick with a traditional agent, clopidogrel, where we have a decade of experience, or should we select a newer agent that has been shown to have better clinical outcomes in certain patient groups and in some cases reduced mortality in clinical trials? Or should we do platelet testing to try to tailor therapy to each patient? What about genetic testing and “personalized medicine” – are these techniques that we can implement now? So many questions!
Professor Ardissino and colleagues provide a terrific summary of all the data to date and provide some insight into how they see the field emerging. They present a great wealth of data supporting clopidogrel, noting that safety and clinical experience are important, but also delineate the types of patients who might profit more from the newer agents. They review the information from the TRITON-TIMI 38 trial of prasugrel in ACS patients undergoing percutaneous coronary intervention. They also present data from the PLATO trial of ticagrelor, including the most recent subgroups of patients and the various aspirin doses used. They have great insight into how these agents work and where they fit into everyday clinical practice.
I can highly recommend this monograph for an up-to-the-minute perspective on dual antiplatelet therapy in ACS.