Dual platelet inhibition in ACS—The Styrian consensus

Dual antiplatelet therapy facilitated treatment of acute coronary syndromes and enabled the wide use of stents after clopidogrel emerged on the market about twenty years ago. Although this was a milestone in cardiology, clopidogrel inherits several disadvantages which are likely to reduce clinical benefit of its use and a new generation of drugs including prasugrel and ticagrelor is now available. One megatrial was done for each substance and various publications regarding subgroups have been published. Since these broad data is difficult to overview, especially for clinicians not focused on cardiology patients, the invasive centers of Styria aimed to design an easy-to use algorithm for dual antiplatelet therapy in ACS. The algorithm divides patients with acute coronary syndromes into STEMI patients with preferred use of prasugrel and NSTEMI patients being preferentially treated with ticagrelor. Only two subgroups were included to facilitate the use of the algorithm. Recommended treatment in diabetic patients is the use of prasugrel and ticagrelor is recommended in small and old patients.