Acute coronary syndrome: potent oral antiplatelets

The thienopyridine clopidogrel, which irreversibly blocks the adenosine diphosphate (ADP) receptor P2Y12 on platelets, has become an essential component of therapy in patients with acute coronary syndromes. However, clopidogrel has drawbacks which has led to the development of newer more potent antiplatelet agents: prasugrel, and ticagrelor. Prasugrel, a thienopyridine, also irreversibly binds to P2Y12. Prasugrel has a more rapid onset of action and a stronger inhibitory effect than clopidogrel. Ticagrelor is a new class of antiplatelet which binds reversibly to P2Y12 with a stronger and more rapid antiplatelet effect than clopidogrel. This article discusses the newer antiplatelet agents and their role in acute coronary syndromes compared to clopidogrel. The article also highlights some of the side effects associated with these newer agents.