The major approaches to prasugrel and ticagrelor in patients with acute coronary syndrome: state of the art

In the setting of the Acute Coronary Syndrome (ACS), Aspirin is recommended for all suspected patients, unless contraindicated. The addition of a second antiplatelet agent such as Clopidogrel, Ticagrelor or Prasugrel is also recommended for most patients. Parenteral anticoagulation is recommended with unfractionated heparin, low molecular weight heparin, Bivalirudin and Fondaparinux [1]. Proton pump inhibitors are recommended to prevent bleeding due to the use of antiplatelet agents and anticoagulation in patients with an aboveaverage risk of gastrointestinal bleeding. Other medical therapies should include statins, angiotensin-converting enzyme inhibitors, betablockers, nitroglycerin and morphine, and oxygen. For patients with ST-segment elevation myocardial infarction, percutaneous coronary intervention (PCI) with stent placement should be performed as soon as possible. However, fibrinolytic therapy should be used first if the PCI takes longer than 120 minutes.