The use of thienopyridine and non-thienopyridine drugs in the management of acute coronary syndrome.

Abstract

In patients with acute coronary syndrome (ACS), antiplatelet therapy using thienopyridine or non-thienopyridine drugs is vital in preventing major cardiovascular events, however, which is the most effective is debatable. Thus, the population, intervention, comparison and outcome (PICO) question of the dissertation is, 'In patients with Acute Coronary Syndrome, how do thienopyridine drugs compared to non-thienopyridine drugs reduce major cardiovascular events?' Articles for this dissertation were gathered from electronic databases, to these inclusion/exclusion criteria were applied in relation to the PICO question - English version randomised control trials (RCTs) published from 2005 onwards with a sound methodology in which participants suffered ACS secondary to coronary artery disease (CAD) but had not undergone surgical interventions, and had clearly specified cardiovascular event. From 403 articles, the six RCTs, consisting of phase II and phase Ill trials, and one meta-analysis selected were critically appraised utilizing the critical appraisal skills programme (CASP) tool. The findings illustrated that the non-thienopyridine Ticagrelor had a marginally better therapeutic effect than Clopidogrel, a . thienopyridine, in preventing major cardiovascular events. Meanwhile, when Ticagrelor was compared with the latest generation of thienopyridine, Prasugrel, the results showed that both drugs had similar efficiencies. Based on evidence based principles both Prasugrel and Ticagrelor are recommended by the European Society of Cardiology (ESC), yet locally Prasugrel has limited use and Ticagrelor is not available. Implementing the ESC recommendations the professional responsibility of all medical officers caring for ACS patients, therefore, it is suggested that these protocols are published in journals and are available on KURA (local intranet hospital service) to reach these professionals along with educational and training strategies to underpin the change in practice. Apart from this, there is still room for more research, particularly comparing the effectiveness of Ticagrelor (non-thienopyridine) and Prasugrel (thienopyridine), while aspiring for the 'gold standard' antiplatelet therapy.