What should be included in dual antiplatelet therapy for long-term management in patients with ACS?

In the context of long-term management for patients with acute coronary syndrome (ACS), dual antiplatelet therapy is crucial for reducing the risk of future cardiovascular events. The recommended regimen typically includes aspirin in combination with a P2Y12 inhibitor, which effectively prevents platelet aggregation and decreases the likelihood of thrombus formation.

Aspirin is a well-established antiplatelet agent that irreversibly inhibits cyclooxygenase-1 (COX-1), leading to decreased production of thromboxane A2, a potent promoter of platelet activation and aggregation. The P2Y12 inhibitors, such as clopidogrel, ticagrelor, or prasugrel, further enhance the antiplatelet effect by blocking the P2Y12 receptor on platelets, which is activated by ADP, reducing platelet activation in a complementary manner.

The specific recommendation is often to use low-dose aspirin, typically 81 mg, which effectively balances efficacy with a reduced risk of bleeding. The addition of a P2Y12 inhibitor extends the protective effects against thrombotic events beyond what aspirin alone can achieve, especially in the vulnerable post-ACS period.

This combination strategy is supported by evidence from clinical trials which demonstrate that dual antiplatelet