A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes

After an acute coronary syndrome, as many as 1 in 5 patients will have a second ischemic event within 5 years. Residual risk is related to several factors that may be mitigated by pharmacologic and nonpharmacologic interventions. Antiplatelet therapy is a cornerstone in the management of acute coronary syndrome. Acetylsalicylic acid (ASA) was introduced as an effective treatment for myocardial infarction almost 5 decades ago and remains the most widely used antiplatelet therapy. Although ASA is effective in reducing mortality rates, combining ASA with a second antiplatelet agent, a P2Y12 receptor inhibitor (known as dual antiplatelet therapy) provides additional benefit and is now the preferred initial strategy for acute coronary syndromes over ASA alone. Here, Alkhalil et al examine emerging evidence regarding the use of antiplatelet therapy in acute coronary syndromes, as well as updates to the Canadian and European Society of Cardiology guidelines that highlight adjustments in the choice and duration of antiplatelet therapy, in addition to ASA). They focus on strategies to reduce bleeding risk after percutaneous coronary intervention.