title: New antiplatelet agents in the treatment of acute coronary syndromes.
abstract: Effective antagonism of the P2Y12 platelet receptor is central to the treatment of acute coronary syndrome (ACS) patients, especially in the setting of percutaneous coronary intervention and stenting. According to consensus guidelines, early revascularization and intensive antiplatelet therapy are key to reducing the complications that arise from myocardial ischaemia and the recurrence of cardiovascular events. Until recently, clopidogrel was the key P2Y12 antagonist advocated, but due to several limitations as an antiplatelet agent, newer drugs with more predictable, rapid and potent effects have been developed. Prasugrel and ticagrelor are now the recommended first-line agents in patients presenting with non-ST-segment elevation ACS and ST-segment elevation ACS, due to large-scale randomized trials that demonstrated net clinical benefit of these agents over clopidogrel, as stated in the European guidelines. Although no study has directly compared the two agents, analysis of the data to date suggests that certain patient types, such as diabetics, those with ST-segment elevation myocardial infarction or renal failure and the elderly may have a better outcome with one agent over the other. Further studies are needed to confirm these differences and answer pending questions regarding the use of these drugs to optimize efficacy while minimizing adverse events, such as bleeding. The aim of this review is to provide an overview of the current P2Y12 receptor antagonists in the treatment of ACS, with a focus on issues of appropriate agent selection, timing of treatment, bleeding risk and the future role of personalized treatment using platelet function and genetic testing.
authors.affiliation: Cardiovascular Prevention Institute, 14 bis, boulevard de l'Hôpital, 75005 Paris, France. Electronic address: pierre.sabouret@psl.aphp.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Sabouret
authors.affiliation: Cardiovascular Medical Unit, Lilly, Neuilly-sur-Seine, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Taiel-Sartral
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000249:Adenosine Monophosphate / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003328:Coronary Thrombosis / Q000150:complications / Q000188:drug therapy; D048909:Diabetes Complications; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D010879:Piperazines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D000068799:Prasugrel Hydrochloride; D057285:Precision Medicine; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D058925:Receptors, Purinergic P2Y12 / Q000187:drug effects / Q000502:physiology; D051437:Renal Insufficiency / Q000150:complications; D013876:Thiophenes / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: C548576:P2RY12 protein, human; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D013876:Thiophenes; D000249:Adenosine Monophosphate; C117446:cangrelor; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: Antagoniste du récepteur P2Y(12); Antiplatelet drugs; Molécules antiplaquettaires; P2Y(12) receptor antagonist; Platelet reactivity; Réactivité plaquettaire