Strategies to optimize initial P2Y₁₂ inhibitor therapy in STEMI patients

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard for ST-elevation myocardial infarction (STEMI) patients post-percutaneous coronary intervention (PCI).
• While DAPT reduces ischemic events, optimal P2Y12 inhibitor administration strategies in STEMI remain under investigation.

Purpose of the Study:

• This review summarizes current evidence on the optimal use of ticagrelor and prasugrel during the acute phase of STEMI.

Main Methods:

• Literature review of current evidence on ticagrelor and prasugrel use in STEMI.
• Analysis of strategies for rapid platelet inhibition in the acute STEMI setting.

Main Results:

• High platelet activity in acute STEMI and PCI necessitates rapid and adequate platelet inhibition.
• Increased ticagrelor/prasugrel loading doses or earlier administration have not fully bridged the platelet inhibition gap.
• Strategies like bridging with intravenous agents or crushing/chewing oral tablets are being explored to enhance early ticagrelor/prasugrel efficacy.

Conclusions:

• Oral ticagrelor/prasugrel before or immediately after STEMI PCI typically suffices to prevent thrombotic complications.
• Crushing or chewing ticagrelor/prasugrel tablets offers an alternative to intravenous P2Y12 inhibitors when faster inhibition is needed or oral administration is difficult.