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Antiplatelets in acute coronary syndrome: personal perspectives

Rossella Marcucci1, Caterina Cenci, Gabriele Cioni

  • 1Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy. rossella.marcucci@unifi.it

Expert Review of Cardiovascular Therapy
|December 21, 2012
PubMed

Insights

High platelet reactivity (HPR) increases vascular risk in acute coronary syndromes. New antiplatelet drugs like prasugrel and ticagrelor show superiority over clopidogrel, paving the way for personalized antiplatelet therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Genetics

Background:

  • High platelet reactivity (HPR) during dual-antiplatelet therapy is a significant vascular risk marker, particularly for stent thrombosis in acute coronary syndromes (ACS).
  • Factors like CYP2C19*2 polymorphism, advanced age, female gender, diabetes, reduced ventricular function, inflammation, and increased platelet turnover contribute to HPR risk.
  • Elevated reticulate platelets during ACS indicate increased platelet turnover and are associated with HPR.

Purpose of the Study:

  • To review the factors associated with high platelet reactivity (HPR) in patients with acute coronary syndromes (ACS).
  • To discuss the development and efficacy of newer antiplatelet agents compared to clopidogrel.
  • To highlight the future prospect of tailoring antiplatelet therapy based on platelet function monitoring.

Main Methods:

  • Review of existing literature and clinical trial data (TRITON TIMI 38, PLATO).
  • Analysis of factors contributing to HPR, including genetic, demographic, and inflammatory markers.
  • Comparison of clinical outcomes between clopidogrel, prasugrel, and ticagrelor.

Main Results:

  • Newer antiplatelet agents, prasugrel and ticagrelor, have demonstrated superiority over clopidogrel in randomized trials.
  • TRITON TIMI 38 and PLATO trials confirmed improved outcomes with prasugrel and ticagrelor, respectively.
  • HPR is linked to specific genetic factors, patient demographics, and inflammatory states during ACS.

Conclusions:

  • Personalized antiplatelet therapy, incorporating platelet function assessment alongside clinical data and risk factors, is the future direction for managing ACS patients.
  • Prasugrel and ticagrelor offer improved efficacy over clopidogrel, addressing limitations of older antiplatelet strategies.
  • Understanding HPR determinants is crucial for optimizing antiplatelet treatment and reducing thrombotic events.

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