Comparative Effectiveness of Different Antiplatelet Regimens in Patients with Acute Coronary Syndrome: A Systematic Review

Abstract

Acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality worldwide. The accumulation of platelets is central to the development and pathogenesis of ACS, making antiplatelet therapy a cornerstone in its management. This review aims to assess the effectiveness of various antiplatelet therapies in patients with ACS. The methodology for this review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 38 studies from the past decade were included, with articles sourced from Google Scholar and PubMed. The findings indicate that traditional antiplatelet agents, such as aspirin and clopidogrel, have been extensively utilized in the treatment of ACS. Despite their benefits, these agents are limited by a slow onset of action, variable efficacy, and relatively low antiplatelet potency. These limitations have been addressed by the development of newer antiplatelet agents, such as rivaroxaban, ticagrelor, and prasugrel, which offer more potent and predictable platelet inhibition. These novel agents have demonstrated a significant reduction in stent thrombosis, major adverse cardiac or cerebral events (MACCE), and mortality rates in patients with ACS. However, they are associated with an increased risk of severe bleeding in some cases. Another approach, dual antiplatelet therapy (DAPT), which involves the combination of different antiplatelet agents, has shown enhanced safety and efficacy in the management of ACS patients. In conclusion, the effectiveness of antiplatelet therapies is influenced by individual patient characteristics and risk factors. Striking the right balance between reducing the risk of major cardiovascular events and minimizing the potential for severe bleeding remains a critical challenge. Further research is needed to refine our treatment strategies for patients with ACS.