Professor Albert Ferro, Kings College, London, UK, and Professor Peter Clemmensen, University of Copenhagen, Denmark discussed the role of antiplatelet agents in the management of acute coronary syndrome. Here, they are joined with Professor Juan Carlos Kaski from St George’s University of London, UK to discuss their presentations.
Professor Ferro began the discussion by outlining the advantages and disadvantages of the new generation of antiplatelet agents. “We have the older agents – aspirin and clopidogrel – and we know they work very well, and we know that dual therapy with aspirin and clopidogrel is a good lifesaver in the setting of acute coronary syndrome,” he says.
“However, we do have new drugs that have some advantages,” he adds. “They have more predictable pharmacokinetics, they are more effective than clopidogrel, and there is a reduced need for routine platelet monitoring of the drugs because there is less variation in response.”
Conversely, these new agents will cause an increase in bleeding “simply because they are more effective than the older agents. And importantly, in these austere times they are significantly more expensive.”
Professor Peter Clemmensen discussed how data from recent studies have resulted in the big societies adopting these new drugs into the guidelines.
“If we look at ticagrelor in the PLATO trial, you did have a significant effect. The drug met the primary end point, and in the secondary analysis we saw there was an impressive decrease in cardiovascular mortality, but also in all-cause mortality,” he says. “It was one of the first trials with a new agent that actually managed to show this effect.”
Another key trial was TRITON which compared prasugrel with clopidogrel in ACS. “Looking at the prasugrel data coming from the TRITON trial, we saw that this was also a positive trial in terms of the composite end point. Although the results for CV mortality was only seen in the secondary analysis,” he adds.
“If you look at all the events in both these trials, not just analysis of the first event, but actually subsequent events, you have a highly significant benefit of these drugs. Of course it’s playing around with statistics, but it’s comforting to know.”