Prasugrel versus ticagrelor for acute coronary syndrome patients undergoing percutaneous coronary intervention: A critical appraisal of randomized controlled trials

Every year, millions of coronary stenting procedures are performed for the treatment of ischemic heart disease. Initially, bare metal stents (BMS) were utilized for acute coronary syndromes (ACS) and myocardial infarctions (MIs). While effective, rates of restenosis with BMS were a concern, subsequently leading to the advent of drug-eluting stents (DES). DES were coated with polymers that enabled the slow and controlled release of anti-proliferative agents, such as sirolimus and paclitaxel. Studies thereafter showed that DES indeed led to a marked decrease in the restenosis rate of stented coronary vessels. Nevertheless, despite the plummeting restenosis rates, thrombosis remained an issue, even in DES, where one of the primary concerns was that their non-biodegradable polymers remained after completing drug release. Thereafter, numerous clinical trials and studies have unequivocally demonstrated that treatment with dual antiplatelet therapy (DAPT), a combination of a P2Y12 antagonist and aspirin, is the go-to strategy for these patients.</p