The major physiopathological mechanism underlying acute coronary syndromes (ACS)
is atherosclerotic plaque rupture with resultant coronary thrombosis, posing a big burden in health
care systems. Dual anti-platelet therapy (DAPT) can improve CV outcome with a prolonged regimen,
albeit at the cost of increased bleeding rates. We performed a narrative literature review on
the topic, in which we explored databases through April 15th, 2020, with no restrictions on language.
Keywords related to antiplatelet therapy, P2Y12 inhibitor, aspirin and DAPT were utilized.
Randomized clinical trials, large prospective studies, systematic reviews and meta-analysis were included.
We hand-searched the reference lists of included articles and relevant reviews. The review
revealed that when choosing antiplatelet agents, the decision should be driven by pharmacodynamic
properties as well as demonstrated efficacy and safety. Additionally, it was noted that in patients
undergoing percutaneous coronary intervention, prasugrel and ticagrelor are preferred. In patients
with a high risk of bleeds or receiving thrombolysis, or when cost or specific patient issues exist,
clopidogrel is considered though it is a second-line therapy. Due to an elevated risk of bleeds, triple
therapy should be avoided, as evidence shows effectiveness and safety with regimens without
ASA. Furthermore, multiple studies have also shown that regimens shorter than 12 months of
DAPT could be adequate for many patients, and newer guidelines are likely to reflect it. There are
specific recommendations for switching among antiplatelets, mostly based on registries and pharmacodynamic