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Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
2020 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the
Jack Wc Tan1,2, Derek P Chew3, Muhamad Ali Sk Abdul Kader4
1National Heart Centre Singapore.
Insights
International dual antiplatelet therapy (DAPT) guidelines may not suit Asia-Pacific patients with acute coronary syndrome. This review summarizes evidence on newer P2Y12 inhibitors for this population.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Acute coronary syndrome (ACS) patient characteristics vary regionally.
- International dual antiplatelet therapy (DAPT) guidelines may not be universally applicable.
- Limited data exist on newer P2Y12 inhibitors in Asian ACS populations.
Purpose of the Study:
- To review current evidence on newer generation P2Y12 inhibitors in Asian ACS patients.
- To provide recommendations for DAPT regimen selection in this demographic.
- To guide management of ischemic and bleeding risks associated with DAPT.
Main Methods:
- Systematic review of existing literature.
- Analysis of clinical outcomes from pivotal and regional studies.
- Synthesis of evidence regarding P2Y12 inhibitor efficacy and safety.
Main Results:
- Newer P2Y12 inhibitors (ticagrelor, prasugrel) show improved outcomes over clopidogrel.
- Asian patient representation in key trials was low.
- Regional studies comparing DAPT regimens are scarce.
Conclusions:
- Individualized DAPT regimens are crucial for Asian ACS patients.
- Guidance is needed on DAPT duration, switching, and de-escalation strategies.
- Further research on DAPT in diverse Asian populations is warranted.
Abstract:
The unique characteristics of patients with acute coronary syndrome in the Asia-Pacific region mean that international guidelines on the use of dual antiplatelet therapy (DAPT) cannot be routinely applied to these populations. Newer generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) have demonstrated improved clinical outcomes compared with clopidogrel. However, low numbers of Asian patients participated in pivotal studies and few regional studies comparing DAPTs have been conducted. This article aims to summarise current evidence on the use of newer generation P2Y12 inhibitors in Asian patients with acute coronary syndrome and provide recommendations to assist clinicians, especially cardiologists, in selecting a DAPT regimen. Guidance is provided on the management of ischaemic and bleeding risks, including duration of therapy, switching strategies and the management of patients with ST-elevation and non-ST-elevation MI or those requiring surgery. In particular, the need for an individualised DAPT regimen and considerations relating to switching, de-escalating, stopping or continuing DAPT beyond 12 months are discussed.
