The role of antiplatelet therapy in the secondary prevention of coronary artery disease

Purpose of review In this study, we review the evidence for both long-standing and newer oral antiplatelet agents as secondary prevention in coronary artery disease, and give our opinion on where each agent's treatment role lies. Recent findings Platelets play a pathological role in acute coronary syndromes and are therefore a major therapeutic target. The caveat to this is that their physiological haemostatic role means there must be a careful balance between preventing ischaemia and not promoting bleeding. In addition to accepted oral agents (aspirin and clopidogrel), more potent antiplatelet agents have recently become available (prasugrel and ticagrelor) at a cost of increased bleeding. Summary There is now a choice of three antiplatelet agents to be used in conjunction with aspirin for secondary prevention with dual antiplatelet therapy. Clinicians must now 'tailor' the correct therapy for each patient, depending on their presentation, clinical features and stage of risk.