Introduction-Use of standard antiplatelet agents like clopidogrel in patients with acute coronary syndrome, has led to a debate due to variation in action and irreversibility of platelet inhibition .This research compared ticagrelor and prasugrel, more potent (hypothesis) newer anti platelets with clopidogrel in such patients in terms of their side effect profile, short term efficacy and cost effectiveness. Aim- To find the best effective newer antiplatelet drug out of ticagrelor, clopidogrel, and prasugrel in acute coronary syndrome patients. Materials And Methods-A planned multicentric observational study on 60 patients hospitalized for acute coronary syndrome (with or without ST elevation) assigned to ticagrelor (loading dose 180mg then 90mg BD), prasugrel (loading dose 60mg then 10mg OD) and clopidogrel (loading dose 300mg then 75mg OD) was done and then followed upto 2 months. Composite end points were cardiovascular death, myocardial infraction, need for PCI or stroke. Results-20 patients were assigned to clopidogrel, 20 to prasugrel and 20 to ticagrelor group. The primary composite end points occurred in fewer patients in prasugrel (15%) and ticagrelor (0%) group than in the clopidogrel group (40%). Statistical analysis using Anova with post hoc turkey test showed that there was significant difference between ticagrelor, clopidogrel and prasugrel in rates of ischemic attacks/week at 2nd, 6th and 8th week. The major side effects found significant statistically were constipation, sleep disturbance and ecchymosis. The cost of clopidogrel was lowest amongst the three drugs but it differs with different brands. Conclusion-The newer anti platelets seem to be a better option than clopidogrel for patients with ACS for whom non invasive strategy is planned. But it needs to be studied on larger sample of patients
