Oral Antiplatelet Therapy for the Management of Acute Coronary Syndromes: Defining the Role of Prasugrel

Antiplatelet therapy is important in the prevention of thrombosis, a significant cause of morbidity and mortality that is associated with acute coronary syndrome. Current evidence supports the general acceptance of aspirin and clopidogrel as the standard of care for the management of all patients experiencing an acute coronary syndrome with or without percutaneous coronary intervention. Thienopyridine antiplatelet agents such as clopidogrel, when used alone and in combination with aspirin, are effective in preventing myocardial infarction and death. Prasugrel, a potent antiplatelet agent that was recently approved by the Food and Drug Administration, may have some advantages over other antiplatelet agents, owing to its rapid onset of action, higher degree of platelet inhibition, and decreased interpatient variability in pharmacokinetics and pharmacodynamics as compared with clopidogrel. However, further studies are required to assess the potential for increased bleeding in high-risk patients.