Presentación y discusión de tres casos clínicos

Dual therapy with acetylsalicylic acid and a P2Y12-receptor inhibitor is the mainstay of antiplatelet treatment in patients with acute coronary syndrome, especially those who have undergone percutaneous revascularization with stent implantation. For over a decade, the P2Y12-receptor inhibitor used in the majority of cases was clopidogrel. In recent years, two new P2Y12-receptor inhibitors have become available: prasugrel and ticagrelor. These two drugs are more potent and faster acting than clopidogrel and responses are less variable. However, this expansion of the therapeutic armamentarium from one to three drugs has raised questions about which antiplatelet drug should be chosen to accompany aspirin in particular cases. Moreover, there are a number of settings in which selecting the best antiplatelet therapy is challenging, such as when a patient has to undergo noncoronary surgery while receiving dual antiplatelet therapy. This article describes three cases chosen to illustrate the problems faced in three different scenarios often encountered in daily clinical practice: a patient with ST-elevation acute coronary syndrome, a patient with non-ST-elevation acute coronary syndrome, and a patient who needed both noncoronary surgery and antiplatelet therapy.