A Tough Pill to Swallow: Clinical Application of Prasugrel in Patients with ACS

The recent results of The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial have, to say the least, brought into question the notion that ticagrelor is a superior P2Y12 inhibitor in patients with ACS. This blog will briefly review the results of ISAR-REACT 5, but more importantly outline key considerations for the use of prasugrel in clinical practice.

3 Things You Should Know Before Throwing in the Towel on Triple Therapy

When it comes to triple therapy, the totality of the evidence strongly suggests “less is more”. While many practitioners have been quick to adopt dual antithrombotic therapy, it is important to consider the external validity of these trials and how we apply them to our patients. In this blog, Dr. Noel offers 3 considerations that require careful reflection before throwing in the towel on triple therapy.

Upstream P2Y12 Inhibitors and the CABG Quandary

Given the extensive role that platelet activation and aggregation play in the pathophysiology of acute coronary syndromes, it seems reasonable to administer a P2Y12 inhibitor as early as possible to minimize thrombus formation and progression of ischemia. Nonetheless, there remains considerable controversy surrounding the optimal timing of P2Y12 inhibitor administration in those undergoing percutaneous coronary intervention. In this blog, we’ll explore the data for and against early P2Y12 inhibitor administration in those presenting with non-ST-segment-elevation acute coronary syndromes and how coronary artery bypass graft surgery should, or should not, impact the decision for when to administer P2Y12 inhibitors.