title: [Dual platelet inhibitors in intensive care units].
abstract: BACKGROUND
  The introduction of clopidogrel was a milestone in the development of modern antiplatelet therapy. However, the shortcomings in the pharmacokinetics of clopidogrel have led to the development of alternative substances.
  The two new drugs prasugrel and ticagrelor were included in the current guidelines for the treatment of patients with acute coronary syndrome. These potent platelet inhibitors, however, are associated with an increased rate of bleeding events, which is of particular importance in critically ill patients. However, the new platelet inhibitors are less effective in patients with cardiogenic shock or patients treated with therapeutic hypothermia.
  
  
  CONCLUSIONS
  Recent studies underscore the assessment of the net clinical benefit in patient management. Since there is only a thin line between efficacy and safety in critically ill patients, future studies for risk stratification of antiplatelet therapy in terms of personalized medicine are mandatory.
authors.affiliation: Universitätsklinik für Innere Medizin II, Abteilung für Kardiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich, jolanta.siller-matula@meduniwien.ac.at.
authors.forename: J M
authors.initials: JM
authors.lastname: Siller-Matula
authors.forename: G
authors.initials: G
authors.lastname: Delle Karth
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D000077144:Clopidogrel; D005858:Germany; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality; D007362:Intensive Care Units; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects*; D057285:Precision Medicine; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine