Use of Antiplatelet Drugs in the Treatment of Acute Coronary Syndromes

Patients with unstable angina pectoris/non-ST-elevation myocardial infarction (NSTEMI) should be treated with dual antiplatelet therapy with the use of aspirin plus either clopidogrel, prasugrel, or ticagrelor depending on the clinical circumstances as discussed in this article. If ticagrelor is used, the dose of aspirin must not exceed 100 mg daily. Prasugrel must not be used in patients with a history of stroke or transient ischemic attack. Platelet glycoprotein IIb/IIIa inhibitors should not be used as part of triple antiplatelet drug therapy if there is an increased risk for bleeding or in non-high-risk patients such as those with a normal baseline cardiac troponin level, nondiabetics, and those aged 75 years and older in whom potential benefit may be significantly offset by the potential risk of bleeding. Clinical trial data in patients with acute coronary syndromes do not support the use of intravenous cangrelor or oral voraxapar in the treatment of these patients.