Zulkarnain, Bambang Subakti and Tamara, Aulia and Yulimanida, Herri and Tiyas, Pratiwi Asih Ayu Ning and Yogiarto, Mohammad and Alsagaff, Mochamad Yusuf and Aryanti, Yuni and Khotib, Junaidi (2026) Effect of different doses of dual antiplatelet therapy in post-coronary stent patients: A prospective observational study from a clinical pharmacy perspective. Tropical Journal of Pharmaceutical Research, 25 (4). 551 - 559.

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Abstract

Purpose: To determine the effect of different dual antiplatelet therapy (DAPT) regimens on selected Indonesian population. Methods: In a prospective study with a total to 70 patients at Dr. Soetomo General Academic Hospital in Indonesia, 3 different groups of patients with acute coronary syndrome (ACS) orally received 90 days of aspirin plus 75 mg clopidogrel (8 patients), or aspirin plus 2 x 90 mg ticagrelor (31 patients), or aspirin plus low-dose (3.75 mg) prasugrel (31 patients) after coronary stenting. The patients were followed up for 90 days. Regimen selection was based on the clinical judgement of cardiologists. The outcomes comprised major adverse cardiovascular events (MACEs) such as all-cause death, non-fatal myocardial infarction, definite or probable stent thrombosis, non-fatal stroke, and ischemia-driven revascularization, in addition to bleeding events using Bleeding Academic Research Consortium (BARC) criteria. Results: Seventy patients completed follow-up. Patients in the aspirin plus clopidogrel group were generally older and potentially at higher bleeding risk. Polypharmacy was prevalent across all groups. Four MACEs occurred in two clopidogrel groups, one ticagrelor group, and one prasugrel group. No major bleeding occurred. However, minor bleeding appeared only in ticagrelor and prasugrel groups. Differences among the regimens were not statistically significant. Conclusion: Short-term outcomes of aspirin plus clopidogrel, aspirin plus ticagrelor, and aspirin plus low-dose prasugrel were broadly comparable in the small, real-world Indonesian cohorts investigated. Notably, the study highlights how clinical pharmacists can strengthen cardiac care through individualized regimen selection, careful medication review in polypharmacy, and counseling to make patients adhere to regimens while safely navigating bleeding concerns. While supportive of national dosing recommendations, the findings should be interpreted cautiously, given the small sample size and non-randomized design used. © 2026 The authors.

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