Prasugrel and ticagrelor are two novel promising antiplatelet agents inhibiting the platelet activation via the adenosine diphosphate pathway. Both achieve a faster, more intense, and more consistent platelet inhibition than clopidogrel. Both novel antiplatelet agents have demonstrated superiority over clopidogrel in large, randomised controlled trials in patients with acute coronary syndrome (ACS). Prasugrel may be best suited for younger patients with planned percutaneous coronary intervention and large areas of myocardium at risk or diabetes mellitus who have a low risk of bleeding. The benefits of prasugrel relative to clopidogrel in ACS must be weighed against the increase in the risk of bleeding associated with its use. Ticagrelor may be the best option for patients with ACS without T elevations, elderly patients or patients managed conservatively. Vorapaxar, a new oral protease-activated-receptor 1 antagonist, may be a good option for secondary prevention in patients with stable atherosclerosis and no history of stroke.
Timm Bauer - Medical Clinic I, University of Giessen, Germany
Christian Hamm - Medical Clinic I, University of Giessen, Germany