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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Antithrombotic therapy for patients with STEMI undergoing primary PCI
Francesco Franchi1, Fabiana Rollini1, Dominick J Angiolillo1
1University of Florida College of Medicine-Jacksonville, Division of Cardiology-ACC Building 5th floor, 655 West 8th Street, Jacksonville, Florida 32209, USA.
Nature Reviews. Cardiology
|February 24, 2017
Summary
Optimizing antithrombotic therapy, including antiplatelet and anticoagulant agents, is crucial for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). This review covers current therapies, trial results, and clinical practice recommendations for better outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Antithrombotic therapy is essential for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).
- Current intravenous agents include unfractionated heparin, low-molecular-weight heparin, bivalirudin, glycoprotein IIb/IIIa inhibitors, and cangrelor.
- Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard, with newer agents like prasugrel and ticagrelor offering improved efficacy over clopidogrel.
Purpose of the Study:
- To review current antithrombotic therapies for STEMI patients undergoing PPCI.
- To analyze pivotal clinical trial data and guideline implications.
- To provide recommendations for clinical practice regarding antithrombotic strategies.
Main Methods:
- Comprehensive literature review of antithrombotic agents and clinical trials.
- Analysis of intravenous and oral antiplatelet and anticoagulant therapies.
- Evaluation of treatment outcomes and adverse events in STEMI patients.
Main Results:
- Prasugrel and ticagrelor demonstrate superior antiplatelet effects and clinical outcomes compared to clopidogrel in PPCI.
- Alternative thrombotic pathways necessitate exploring novel strategies targeting thrombin and coagulation factors.
- Oral anticoagulants like rivaroxaban and thrombin receptor antagonists like vorapaxar are being investigated.
Conclusions:
- Current first-line antithrombotic therapy for STEMI undergoing PPCI involves dual antiplatelet therapy with newer P2Y12 inhibitors.
- Addressing residual ischemic events may require targeting alternative pathways, including direct thrombin inhibition or receptor antagonism.
- Evidence-based recommendations guide the optimal use of these therapies to improve patient outcomes.
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