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The promise of effective P2Y 12 platelet receptor pretreatment: Not crushed yet
Author(s) -
Chatterjee Arka,
Hillegass William B.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27512
Subject(s) - prasugrel , medicine , clopidogrel , ticagrelor , cangrelor , acute coronary syndrome , mace , platelet , platelet aggregation inhibitor , randomized controlled trial , platelet inhibition , p2y12 , pharmacology , aspirin , anesthesia , percutaneous coronary intervention , myocardial infarction
Key Points Pre‐treatment with intact oral clopidogrel and prasugrel tablets in a representative observational study is not associated with altered ischemic or bleeding outcomes in acute coronary syndrome (ACS) patients. Limited by cost, cangrelor, a rapidly acting intravenous P2Y 12 platelet receptor inhibitor, achieved meaningful reductions in major adverse cardiovascular events (MACE) and stent thrombosis (ST) compared to oral clopidogrel pretreatment. Crushed prasugrel and ticagrelor (CP&T) administered orally achieve accepted thresholds of therapeutic platelet inhibition in one hour in approximately 2/3rds of patients compared to 1/3rd with intact oral tablets. A large, simple randomized trial should test whether CP&T pre‐treatment could capture some of the potential outcome benefit of rapid P2Y 12 inhibition at no incremental risk and cost.