P2Y12-receptor-inhibiting antiplatelet strategies in acute coronary syndromes.
Antiplatelet therapy in acute coronary syndromes is essential for preventing stent thrombosis and for reducing major adverse cardiovascular events. Treatment strategy has changed over the last years by frequent use of more active agents inhibiting the ADP mediated activation of platelets instead of clopidogrel, such as prasugrel and ticagrelor. Compared to clopidogrel these modern antiplatelet drugs showed a significant reduction of efficacy endpoints as well as an acceptable safety profile in large multicenter randomized trials (TRITON TIMI 38, PLATO). Going in with higher efficacy a generally higher bleeding risk of prasugrel could be reduced by optimizing the maintenance dose in elderly and underweight patients (TRILOGY-ACS). However even prasugrel and ticagrelor have shown a delayed onset of action in special patient populations (e.g. STEMI) suggesting that the optimal ADP inhibitor has not been found yet. Results of the CHAMPION PHOENIX trial indicate that cangrelor, an intravenous agent, might fulfill these high expectations of an ideal platelet inhibitor in the first hours of an ACS in special patient cohorts. This review summarizes the results of most important clinical studies investigating the novel P2Y12 receptor inhibiting antiplatelet drugs.
Thomas Höchtl, MD, 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Montleartstrasse 37, 1160 Vienna, Austria, Tel. +43/1/492 50 23 01, Fax +43/1/491 50 23 09 E-mail: thomas.hoechtl@wienkav.at.
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D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D015195:Drug Design; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects* / Q000145:classification; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects* / Q000145:classification; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists
Antiplatelet agents; acute coronary syndrome; cangrelor; prasugrel; ticagrelor