title: Pharmacotherapeutic considerations for the use of prasugrel and ticagrelor to reduce stent thrombosis in patients with acute coronary syndrome.
abstract: Despite the improvement in stent technology, stent thrombosis (ST), a potentially catastrophic event, still occurs. Among several risk factors for ST, high on-treatment platelet reactivity to clopidogrel has been demonstrated to play a role, occurring in about one-third of the patients. In order to overcome this limitation, prasugrel and ticagrelor, newer P2Y12 inhibitors, have been developed and approved for clinical use. Two large clinical trials, TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel-thrombolysis in myocardial infarction (TRITON-TIMI) 38 and Study of Platelet Inhibition and Patient Outcomes (PLATO), evaluated these drugs in patients with acute coronary syndrome (ACS), showing a significant improvement in efficacy end points (including a prominent reduction in ST occurrence) compared to clopidogrel. In contrast, the TRILOGY ACS trial found no benefit with prasugrel compared to clopidogrel in patients with medically treated ACS. The aim of this review is to consider decision-making strategies between prasugrel and ticagrelor in daily clinical practice.
authors.affiliation: 1Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piccolo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gioia
authors.forename: Tullio
authors.initials: T
authors.lastname: Niglio
authors.forename: Carolina
authors.initials: C
authors.lastname: D'Anna
authors.forename: Roberta
authors.initials: R
authors.lastname: De Rosa
authors.forename: Teresa
authors.initials: T
authors.lastname: Strisciuglio
authors.forename: Michele
authors.initials: M
authors.lastname: Bevilacqua
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
authors.forename: Plinio
authors.initials: P
authors.lastname: Cirillo
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galasso
mesh_terms: D054058:Acute Coronary Syndrome; D000241:Adenosine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D003328:Coronary Thrombosis / Q000517:prevention & control*; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention; D010879:Piperazines / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D015607:Stents; D013876:Thiophenes / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D000077486:Ticagrelor
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine