Background: According to ACC/ AHA guidelines, a minimum of 1 year of dual anti- platelet therapy
(DAPT) consisting of aspirin and a platelet ADP-receptor antagonist (P2Y12 inhibitor) is recommended for patients
presenting acute coronary syndromes (ACS), regardless of which type of revascularization is performed
during the acute event.
Methods: The purpose of this presentation was to review the present data either from a direct randomized comparison
among the three compounds and also large prospective observational registries and meta-analysis were
analyzed in detail. With this aim, we performed an extensive large search from PubMed/Medline Journals identifying
studies comparing fashion the new P2Y12 inhibitors in patients with ACS including ST elevation myocardial
infarction (STEMI) in direct and indirect manner.
Results: Pivotal large randomized clinical trials (RCT) in patients with ACS including STEMI, comparing clopidogrel,
a first generation P2Y12 inhibitor against the newer prasugrel and ticagrelor showed major efficacy advantages
of the latters although both drugs had more bleeding risk than clopidogrel. Direct comparisons of prasugrel
and ticagrelor from large RCT are not yet available, however, several observational registries and metaanalysis
reported results from an indirect comparison between both compounds. Major findings and limitations of
each of these studies were identified, highlighted and discussed.
Conclusion: Prasugrel and ticagrelor are both more effective than clopidogrel to prevent adverse cardiac events
in patients with ACS. Compared to ticagrelor, prasugrel appears to be more effective in patients with STEMI,
although lack of randomized data didn’t allow to draw definitive conclusions.