Effects of P2Y12 Receptor Inhibition in Patients With ST-Segment Elevation Myocardial Infarction
In ST-segment elevation myocardial infarction (STEMI), an effective antiplatelet treatment adjunctive to primary percutaneous coronary intervention is of utmost importance. High dose of clopidogrel, prasugrel, or ticagrelor provides a faster, more potent, and more consistent platelet inhibition than...
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| Veröffentlicht in: | The American journal of cardiology 2014-06, Vol.113 (12), p.2064-2069 |
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| creator | Alexopoulos, Dimitrios, MD Xanthopoulou, Ioanna, MD Goudevenos, John, MD |
| description | In ST-segment elevation myocardial infarction (STEMI), an effective antiplatelet treatment adjunctive to primary percutaneous coronary intervention is of utmost importance. High dose of clopidogrel, prasugrel, or ticagrelor provides a faster, more potent, and more consistent platelet inhibition than standard clopidogrel. Oral P2Y12 inhibitors have been studied in large clinical trials and are in use in clinical practice. Intravenously administered P2Y12 inhibitors such as cangrelor have also been tested. However, statistically significant anti-ischemic superiority of stronger platelet inhibition regimens versus standard clopidogrel has not been proved exclusively in patients receiving primary percutaneous coronary intervention. Whether orally administered antiplatelet agents suffice in patients with STEMI has been recently disputed, mainly because of their delayed onset of action. Platelet reactivity variability before P2Y12 blockade and its evolution over time, genetic predisposition, antiplatelet agent used, timing, and method of platelet function testing significantly affect the rates of high on-treatment platelet reactivity. Although ominous signs of greater bleeding potential of stronger antiplatelet regimens have not appeared in STEMI, this should be carefully tested. |
| doi_str_mv | 10.1016/j.amjcard.2014.03.053 |
| format | Article |
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High dose of clopidogrel, prasugrel, or ticagrelor provides a faster, more potent, and more consistent platelet inhibition than standard clopidogrel. Oral P2Y12 inhibitors have been studied in large clinical trials and are in use in clinical practice. Intravenously administered P2Y12 inhibitors such as cangrelor have also been tested. However, statistically significant anti-ischemic superiority of stronger platelet inhibition regimens versus standard clopidogrel has not been proved exclusively in patients receiving primary percutaneous coronary intervention. Whether orally administered antiplatelet agents suffice in patients with STEMI has been recently disputed, mainly because of their delayed onset of action. Platelet reactivity variability before P2Y12 blockade and its evolution over time, genetic predisposition, antiplatelet agent used, timing, and method of platelet function testing significantly affect the rates of high on-treatment platelet reactivity. Although ominous signs of greater bleeding potential of stronger antiplatelet regimens have not appeared in STEMI, this should be carefully tested.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2014.03.053</identifier><identifier>PMID: 24793666</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Administration, Oral ; Aged ; Blood platelets ; Cardiovascular ; Combined Modality Therapy ; Confidence intervals ; Coronary vessels ; Dose-Response Relationship, Drug ; Drug therapy ; Electrocardiography - methods ; Female ; Heart attacks ; Heart surgery ; Hemorrhage - chemically induced ; Hemorrhage - epidemiology ; Humans ; Infusions, Intravenous ; Intervention ; Ischemia ; Male ; Middle Aged ; Mortality ; Myocardial Infarction - diagnosis ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Percutaneous Coronary Intervention - methods ; Percutaneous Coronary Intervention - mortality ; Platelet Aggregation Inhibitors - administration & dosage ; Platelet Aggregation Inhibitors - adverse effects ; Prognosis ; Purinergic P2Y Receptor Antagonists - administration & dosage ; Purinergic P2Y Receptor Antagonists - adverse effects ; Randomized Controlled Trials as Topic ; Risk Assessment ; Stroke ; Studies ; Survival Analysis ; Thrombosis ; Ticlopidine - administration & dosage ; Ticlopidine - adverse effects ; Ticlopidine - analogs & derivatives ; Treatment Outcome</subject><ispartof>The American journal of cardiology, 2014-06, Vol.113 (12), p.2064-2069</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. 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High dose of clopidogrel, prasugrel, or ticagrelor provides a faster, more potent, and more consistent platelet inhibition than standard clopidogrel. Oral P2Y12 inhibitors have been studied in large clinical trials and are in use in clinical practice. Intravenously administered P2Y12 inhibitors such as cangrelor have also been tested. However, statistically significant anti-ischemic superiority of stronger platelet inhibition regimens versus standard clopidogrel has not been proved exclusively in patients receiving primary percutaneous coronary intervention. Whether orally administered antiplatelet agents suffice in patients with STEMI has been recently disputed, mainly because of their delayed onset of action. Platelet reactivity variability before P2Y12 blockade and its evolution over time, genetic predisposition, antiplatelet agent used, timing, and method of platelet function testing significantly affect the rates of high on-treatment platelet reactivity. Although ominous signs of greater bleeding potential of stronger antiplatelet regimens have not appeared in STEMI, this should be carefully tested.</description><subject>Acute coronary syndromes</subject><subject>Administration, Oral</subject><subject>Aged</subject><subject>Blood platelets</subject><subject>Cardiovascular</subject><subject>Combined Modality Therapy</subject><subject>Confidence intervals</subject><subject>Coronary vessels</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug therapy</subject><subject>Electrocardiography - methods</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart surgery</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - epidemiology</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Intervention</subject><subject>Ischemia</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - 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Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alexopoulos, Dimitrios, MD</au><au>Xanthopoulou, Ioanna, MD</au><au>Goudevenos, John, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of P2Y12 Receptor Inhibition in Patients With ST-Segment Elevation Myocardial Infarction</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2014-06-15</date><risdate>2014</risdate><volume>113</volume><issue>12</issue><spage>2064</spage><epage>2069</epage><pages>2064-2069</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>In ST-segment elevation myocardial infarction (STEMI), an effective antiplatelet treatment adjunctive to primary percutaneous coronary intervention is of utmost importance. High dose of clopidogrel, prasugrel, or ticagrelor provides a faster, more potent, and more consistent platelet inhibition than standard clopidogrel. Oral P2Y12 inhibitors have been studied in large clinical trials and are in use in clinical practice. Intravenously administered P2Y12 inhibitors such as cangrelor have also been tested. However, statistically significant anti-ischemic superiority of stronger platelet inhibition regimens versus standard clopidogrel has not been proved exclusively in patients receiving primary percutaneous coronary intervention. Whether orally administered antiplatelet agents suffice in patients with STEMI has been recently disputed, mainly because of their delayed onset of action. Platelet reactivity variability before P2Y12 blockade and its evolution over time, genetic predisposition, antiplatelet agent used, timing, and method of platelet function testing significantly affect the rates of high on-treatment platelet reactivity. Although ominous signs of greater bleeding potential of stronger antiplatelet regimens have not appeared in STEMI, this should be carefully tested.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24793666</pmid><doi>10.1016/j.amjcard.2014.03.053</doi><tpages>6</tpages></addata></record> |
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| subjects | Acute coronary syndromes Administration, Oral Aged Blood platelets Cardiovascular Combined Modality Therapy Confidence intervals Coronary vessels Dose-Response Relationship, Drug Drug therapy Electrocardiography - methods Female Heart attacks Heart surgery Hemorrhage - chemically induced Hemorrhage - epidemiology Humans Infusions, Intravenous Intervention Ischemia Male Middle Aged Mortality Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocardial Infarction - therapy Percutaneous Coronary Intervention - methods Percutaneous Coronary Intervention - mortality Platelet Aggregation Inhibitors - administration & dosage Platelet Aggregation Inhibitors - adverse effects Prognosis Purinergic P2Y Receptor Antagonists - administration & dosage Purinergic P2Y Receptor Antagonists - adverse effects Randomized Controlled Trials as Topic Risk Assessment Stroke Studies Survival Analysis Thrombosis Ticlopidine - administration & dosage Ticlopidine - adverse effects Ticlopidine - analogs & derivatives Treatment Outcome |
| title | Effects of P2Y12 Receptor Inhibition in Patients With ST-Segment Elevation Myocardial Infarction |
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