Progress in platelet blockers: the target is the P2Y12 receptor

Area of Science:

• Pharmacology
• Cardiovascular Medicine
• Thrombosis Research

Background:

• P2Y12-platelet blockers are crucial in preventing thrombotic events.
• Advances have introduced novel agents beyond clopidogrel, impacting perioperative care.
• Understanding these agents' properties is vital for clinical decision-making.

Purpose of the Study:

• To review the perioperative implications of novel P2Y12-platelet blockers.
• To compare the characteristics, benefits, and limitations of agents like prasugrel, ticagrelor, cangrelor, and elinogrel.
• To highlight the potential of new agents in various clinical settings.

Main Methods:

• Review of current literature on P2Y12-platelet inhibitors.
• Comparative analysis of pharmacokinetic and pharmacodynamic profiles.
• Discussion of clinical trial data regarding efficacy and safety, particularly in the perioperative period.

Main Results:

• Prasugrel offers greater potency than clopidogrel but carries risks due to irreversibility.
• Ticagrelor is a reversible oral option but has a unique side-effect profile.
• Cangrelor and elinogrel provide intravenous reversible blockade, with elinogrel also offering oral potential; both are in development.

Conclusions:

• Novel P2Y12 inhibitors present significant perioperative considerations.
• The choice of agent requires balancing potency, reversibility, and bleeding risk.
• Ongoing trials will further define the safety and efficacy of these agents in diverse clinical scenarios, including perioperative management.