Major trials of antiplatelet agents in acute coronary syndrome ± unstable angina
| Antiplatelet agent | Mechanism of action | Trial | Comparison | (Primary) end point |
Risk reduction (time point) |
| Aspirin | COX-1 inhibitor | The ISIS-2 collaborators (ISIS-2), 1979 The Risk Group, 199051 Lewis et al, 198352 Cairns et al, 198553 | aspirin versus placebo aspirin versus placebo aspirin versus placebo aspirin versus placebo | Vascular mortality MI or death MI or death MI or death | 23% (5 weeks) 74% (3 months) 51% (3 months) 51% (2 years) |
| Ticlopidine | P2Y12 antagonist | Scrutinio et al (STAMI), 2001 | aspirin versus ticlopidine | Death, MI, stroke or angina | ns (6 months) |
| Clopidogrel | P2Y12 antagonist | Bertrand et al (CLASSICS), 2000 Yusuf et al (CURE), 2001 The COMMIT Group (COMMIT), 2005 Sabatine et al (CLARITY), 2005 | aspirin + clopidogrel versus aspirin + ticlopidine aspirin + clopidogrel versus aspirin aspirin + clopidogrel versus aspirin aspirin + clopidogrel versus aspirin | Cardiac death, MI, or TLR CV death, MI or stroke Death, MI or stroke CV death, MI or urgent TVR | ns (30 days) 20% (1 year) 9% (discharge or 28 days) 20% (30 days) |
| Prasugrel | P2Y12 antagonist | Wiviott et al (TRITON), 2007 | aspirin + prasugrel versus aspirin + clopidogrel | CV death, MI or stroke | 19% (1 year) |
| Ticagrelor | P2Y12 antagonist | Steg et al (PLATO), 2010 | aspirin + ticagrelor versus aspirin + clopidogrel | CV death, MI or stroke | 13% (1 year) |
| Dipyridamole | PDE inhibitor | The PARIS Research Group (PARIS-1), 1980 White et al, 199554 | aspirin + dipyridamole versus aspirin aspirin + dipyridamole versus aspirin | Cardiac death or MI Prevention of late reocclusion | ns (20 months) ns (1 year) |
| Cilostazol | PDE inhibitor | Lee et al (DECLARE-LONG II), 2011 | Cilostazol + standard care versus standard care | In-stent late loss | 18% (8 months) |
| Abciximab | GPIIb/IIIa inhibitor | The EPIC Investigators (EPIC), 1994 The CAPTURE Investigators (CAPTURE), 1997 Kastrati et al (ISAR-REACT 2), 2006 Simoons et al (GUSTO IV-ACS), 2001 Kastrati et al (IASR-REACT 4), 2011 | 12-hour infusion versus placebo 24-hour infusion versus placebo 12-hour infusion versus placebo 24-hour or 48-hour infusion versus placebo Abciximab + heparin versus bivalirudin | Death, MI or urgent revascularisation Death, MI or urgent revascularisation Death, MI or urgent TVR Death or MI Death, MI, urgent TVR or major bleeding | 35% (30 days) 29% (30 days) 24% (30 days) ns (30 days) ns (30 days) |
| Eptifibatide | GPIIb/IIIa inhibitor | The PURSUIT Investigators (PURSUIT), 1998 | Bolus and 72-hour infusion versus placebo | Death or MI | 10% (30 days) |
| Tirofiban | GPIIb/IIIa inhibitor | The PRISM investigators (PRISM), 1998 The PRISM investigators (PRISM-PLUS), 1998 | Bolus and 48-hour infusion versus placebo Bolus and 72-hour infusion versus placebo | Death, MI, refractory ischaemia or readmission for UA Death, MI or refractory ischaemia | ns (30 days) 17% (30 days) |
| Vorapaxar | PAR-1 antagonist | Tricoci et al (TRACER), 2012 | vorapaxar + standard care versus standard care | CV, death, MI, readmission with ischaemia, urgent revascularisation | ns (median 502 days) |
COX-1, cyclo-oxygenase-1; CV, cardiovascular; GP, glycoprotein; MI, myocardial infarction; PAR-1, protease-activated receptor-1; PDE, phosphodiesterase; TLR, target lesion revascularisation; TVR, target vessel revascularisation; UA, unstable angina.