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Antiplatelet therapy with one or more of these drugs decreases the ability of blood clots to form by interfering with the platelet activation process in primary hemostasis. Antiplatelet drugs can reversibly or irreversibly inhibit the process involved in platelet activation resulting in decreased tendency of platelets to adhere to one another ...
In patients with non-ST elevation acute coronary syndrome current guidelines also recommend immediate administration of dual antiplatelet therapy upon diagnosis; clopidogrel and ticagrelor are indicated in this setting, with ticagrelor considered superior for patients undergoing early invasive strategy (see later).
A dual therapy stent is a coronary artery stent that combines the technology of an antibody-coated stent and a drug-eluting stent. [1] Currently, second-generation drug-eluting stents require long-term use of dual-antiplatelet therapy, which increases the risk of major bleeding occurrences in patients. [2]
Ticagrelor, as monotherapy, dual antiplatelet therapy (DAPT), and in comparison to clopidogrel, is associated with decreased all-cause mortality. When in comparison to clopidogrel, there is evidence for increased risk of bleeding. [38]
For many years dual treatment with the cyclooxygenase-1 (COX-1) inhibitor aspirin and clopidogrel was routine practice and served as the main antiplatelet agents for the prevention of thrombotic events as they have the capability to powerfully manipulate platelet biology, which plays a central part in thrombosis.
The combination of a P2Y 12 inhibitor and aspirin, called dual antiplatelet treatment, remains the first-line treatment for acute coronary syndrome. A 2019 randomized trial suggested that prasugrel is superior to ticagrelor.
Since platelets are involved in the clotting process, patients must take dual antiplatelet therapy starting immediately before or after stenting: usually an ADP receptor antagonist (e.g. clopidogrel or ticagrelor) for up to one year and aspirin indefinitely. [26] [1]
Dual antiplatelet therapy (e.g., use of both aspirin and clopidogrel) should continue if the person with a LGIB underwent stenting of the heart's coronary arteries within the last 30 days or a recent acute coronary syndrome episode (e.g., unstable angina or a myocardial infarction) within 90 days of the LGIB event. [2]