Current Evidence on Platelet P2Y12 Receptor Inhibitors: Is There Still a Role for Clopidogrel in 2015?

Antiplatelets play a significant role in the management of patients with coronary disease. Novel inhibitors of the platelet P2Y12 receptor have more rapid, potent, and consistent inhibitory effect on platelets compared with clopidogrel. Evidence from large clinical studies have defined populations in which novel agents are superior to clopidogrel. Ticagrelor or prasugrel in addition to aspirin should be used preferentially for patients with ST-elevation myocardial infarction because of significant anti-ischemic benefits. In patients with non-ST segment elevation acute coronary syndromes, ticagrelor has proven superiority over clopidogrel whether or not an invasive strategy is adopted, and prasugrel has been shown to be beneficial when started at the time of percutaneous coronary intervention. Of note, neither prasugrel nor ticagrelor have been studied in patients who underwent percutaneous coronary intervention for stable coronary disease or those who required 'triple therapy.' In these situations, clopidogrel should remain the default until further data are available. Prolonged use of clopidogrel in patients with drug-eluting stents beyond 12 months is emerging as a novel indication for the agent.