Dual antiplatelet therapy: Management in general practice

Background: Prasugrel and ticagrelor are two new antiplatelet agents being used in the management of acute coronary syndromes. The number of patients in the community managed on these medications is growing, and thus, it is essential that general practitioners have a good understanding of these agents and their evidence-based applications. Objective: The pharmacokinetic and pharmacodynamic properties of common and new antiplatelet agents will be reviewed, along with the evidence supporting their use. Safety and side effect profiles will be discussed, and some common general practice case scenarios presented. Discussion: Aspirin is still the mainstay of therapy in patients with acute coronary syndromes. The addition of clopidogrel, prasugrel or ticagrelor can reduce morbidity and mortality in selected patients. Patient factors including bleeding risk, renal function and time since coronary stent insertion must be reviewed before these agents are initiated and before making any changes to the medication regimen.