title: How to manage prasugrel and ticagrelor in daily practice.
abstract: Prasugrel and ticagrelor are next-generation antiplatelet agents that provide a rapider and more potent inhibition of platelet P2Y12 receptor than clopidogrel. In combination with aspirin, these new P2Y12 inhibitors are now the first line treatments for patients with acute coronary syndrome. However, these potent antiplatelet agents introduce a new paradigm in the daily management of antithrombotic drugs, particularly when an invasive procedure is planned. The pharmacology of these antiplatelet agents, and the results of the main clinical trials, are reviewed with a special focus on good prescription practices (indications, contra-indications, drug interactions), and on peri-operative management. Strategies are proposed for safely reducing the bleeding risk in elderly patients, in patients requiring concomitant oral anticoagulant therapy, or in patients with an increased haemorrhagic risk.
authors: Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland. Electronic address: fanny.bonhomme@hcuge.ch.
authors: Fanny
authors: F
authors: Bonhomme
authors: Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland.
authors: Pierre
authors: P
authors: Fontana
authors: Geneva Platelet Group, Faculty of Medicine, University of Geneva, Switzerland; Division of General Internal Medicine and Rehabilitation, Trois-Chêne, Geneva University Hospitals, Geneva, Switzerland.
authors: Jean-Luc
authors: JL
authors: Reny
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D000068799:Prasugrel Hydrochloride; D011300:Preoperative Care; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D012307:Risk Factors; D013876:Thiophenes / 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
keywords: Blood loss; Peri-operative period; Pharmacology; Prasugrel; Surgical; Ticagrelor