Management of Antithrombotic Therapy after Acute Coronary Syndromes

This comprehensive review outlines current strategies for managing antithrombotic therapy following acute coronary syndromes (ACS). Dual antiplatelet therapy (DAPT) typically aspirin plus a P2Y₁₂ inhibitor (clopidogrel, prasugrel, or ticagrelor) remains the cornerstone of early post-ACS care. Guidelines favor ticagrelor or prasugrel over clopidogrel for their potency and predictability, though ticagrelor may cause dyspnea and prasugrel is reserved for PCI patients. Therapy duration is individualized: a 12-month course is standard, but extended DAPT can benefit high-risk patients while raising bleeding risk. Recent trials explore aspirin discontinuation after 1–3 months, continuing P2Y₁₂ monotherapy to reduce bleeding without increasing ischemic events. Anticoagulants are essential in early hospitalization (e.g., enoxaparin, bivalirudin), while long-term use post-discharge is less clearly defined. In atrial fibrillation with ACS, triple therapy poses high bleeding risk; dual therapy with DOAC plus clopidogrel is preferred, transitioning to monotherapy for stable patients

This comprehensive review outlines current strategies for managing antithrombotic therapy following acute coronary syndromes (ACS). Dual antiplatelet therapy (DAPT) typically aspirin plus a P2Y₁₂ inhibitor (clopidogrel, prasugrel, or ticagrelor) remains the cornerstone of early post-ACS care. Guidelines favor ticagrelor or prasugrel over clopidogrel for their potency and predictability, though ticagrelor may cause dyspnea and prasugrel is reserved for PCI patients. Therapy duration is individualized: a 12-month course is standard, but extended DAPT can benefit high-risk patients while raising bleeding risk. Recent trials explore aspirin discontinuation after 1–3 months, continuing P2Y₁₂ monotherapy to reduce bleeding without increasing ischemic events. Anticoagulants are essential in early hospitalization (e.g., enoxaparin, bivalirudin), while long-term use post-discharge is less clearly defined. In atrial fibrillation with ACS, triple therapy poses high bleeding risk; dual therapy with DOAC plus clopidogrel is preferred, transitioning to monotherapy for stable patients