A practical guide to the use of P2Y12 inhibitors in acute coronary syndrome Review article

Abstract

P2Y12 receptor inhibitors are a key component of pharmacotherapy for patients with acute coronary syndrome. The European Society of Cardiology?s 2023 guidelines recommend ticagrelor or prasugrel as preferred P2Y12 inhibitors for most acute coronary syndrome patients. Clopidogrel remains a valuable option in special situations, such as when anticoagulation therapy is needed or there is a high risk of bleeding. This article presents the differences between available P2Y12 inhibitors and proposes a practical algorithm for selecting them. The algorithm considers the acute coronary syndrome treatment strategy (percutaneous coronary intervention vs. conservative management), patient age, contraindications, and risk of bleeding complications. This article compiles current clinical data and guideline recommendations in a practical format to facilitate rapid therapeutic decision-making.