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Switching between P2Y12 antagonists - From bench to bedside.
Aleksandra Gasecka1, Michał Konwerski2, Justyna Pordzik3
11st Chair and Department of Cardiology, Medical University of Warsaw, Poland; Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, the Netherlands.
Vascular Pharmacology
|January 28, 2019
Summary
Understanding P2Y12 antagonists is crucial for tailoring antiplatelet therapy. This review guides optimal switching strategies between these drugs, especially in complex clinical situations.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis
Background:
- Platelet P2Y12 receptors are vital for platelet activation and thrombus formation.
- P2Y12 antagonists are essential for preventing atherothrombotic events post-percutaneous coronary intervention (PCI).
Purpose of the Study:
- To provide guidance on switching between different P2Y12 antagonists.
- To address controversial clinical scenarios with scarce evidence on optimal switching strategies.
Main Methods:
- Review of pharmacological properties of P2Y12 antagonists.
- Analysis of recent pharmacodynamic studies, clinical trials, and registries.
- Evaluation of factors influencing P2Y12 antagonist efficacy and safety.
Main Results:
- Multiple oral P2Y12 antagonists (clopidogrel, prasugrel, ticagrelor) and an intravenous option (cangrelor) allow for individualized therapy.
- An International Expert Consensus offers initial recommendations for switching between P2Y12 antagonists.
Conclusions:
- Individualizing antiplatelet therapy requires understanding P2Y12 antagonist properties and clinical evidence.
- Optimal switch strategies are crucial in complex scenarios where evidence is limited.
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