title: Early P2Y12 inhibition in ST-segment elevation myocardial infarction: Bridging the gap.
abstract: Rapid and consistent platelet inhibition represents the cornerstone of pharmacologic treatment in the early hours of ST-segment elevation myocardial infarction (STEMI). Oral P2Y12 inhibitors are recommended to be administered as early as possible in patients with STEMI undergoing primary percutaneous coronary intervention. However, a delay in the onset of antiplatelet agent effects has been recently described in the first several hours after oral administration of clopidogrel, prasugrel, and ticagrelor. As a result, primary percutaneous coronary intervention is performed in most cases with P2Y12 inhibition that may be inadequate. Several strategies may be applied in order to "bridge the gap" in platelet inhibition after oral P2Y12 inhibitors in STEMI, such as upstream administration of P2Y12 inhibitors, loading dose modification, use of an intravenous P2Y12 inhibitor, or glycoprotein IIb/IIIa inhibitors' administration. These strategies may further improve clinical outcomes in this high-risk "golden window."
authors.affiliation: The Department of Cardiology, Patras University Hospital, Rion, Patras, Greece. Electronic address: dalex@med.upatras.gr.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Kerckhoff Heart and Thoraxcenter, Bad Nauheim Medical Clinic I, University of Giessen, Giessen, Germany.
authors.forename: Chistian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Département Hospitalo-Universitaire FIRE, Hôpital Bichat, AP-HP, Paris, France; INSERM U1148, NHLI, Paris, France; Imperial College, ICMS, Royal Brompton Hospital, London, UK.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D000077144:Clopidogrel; D061345:Early Medical Intervention / Q000379:methods*; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D010879:Piperazines / Q000008:administration & dosage* / Q000493:pharmacokinetics; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000493:pharmacokinetics; D013876:Thiophenes / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010879:Piperazines; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine