How to manage prasugrel and ticagrelor in daily practice

Abstract

Prasugrel and ticagrelor are next-generation antiplatelet agents that provide a rapider and more potent inhibition of platelet P2Y12 receptor than clopidogrel. In combination with aspirin, these new P2Y12 inhibitors are now the first line treatments for patients with acute coronary syndrome. However, these potent antiplatelet agents introduce a new paradigm in the daily management of antithrombotic drugs, particularly when an invasive procedure is planned. The pharmacology of these antiplatelet agents, and the results of the main clinical trials, are reviewed with a special focus on good prescription practices (indications, contra-indications, drug interactions), and on peri-operative management. Strategies are proposed for safely reducing the bleeding risk in elderly patients, in patients requiring concomitant oral anticoagulant therapy, or in patients with an increased haemorrhagic risk.

Duration of clopidogrel-based dual antiplatelet therapy and clinical outcomes after endeavor sprint zotarolimus-eluting stent implantation in patients presenting with acute coronary syndrome

“…During the study period, P2Y12 receptor inhibitors other than clopidogrel were not available in Korea. However, the contemporary choice of P2Y12 receptor inhibitors in ACS patients is ticagrelor or prasugrel [1,21]. Therefore, the strategy of DAPT used in this study does not reflect the current clinical practice.…”

Preoperative Evaluation Before Non-Cardiac Surgery in Patients with Percutaneous Coronary Intervention: Review

“…30 Yüksek stent tromboz riski olan hastalarda, GpIIb/IIIa reseptör inhibitörlerinden tirofiban'a iş-lemden birkaç gün önce başlanması, dört saat ön-cesinden kesilmesi, işlemden dört saat sonra tekrar başlanılması ve P2Y12 inhibitörleri başlanıncaya kadar devam edilmesi tavsiye edilmektedir. 5,14,34 İkili antitrombositer tedavi alanlarda anestezi yöntemleri arasında; spinal veya epidural anestezi önerilmemektedir. Midazolam gibi anestezide kullanılan ilaçların klopidogrel ile etkileşimi de söz konusudur.…”

Coronary Artery Bypass Graft Surgery in Patients on Ticagrelor Therapy Is Not Associated with Adverse Perioperative Outcomes

“…However, premature discontinuation of antiplatelet therapy in these settings has been associated with an increase in ischemic complications (8)(9)(10)(11) and a reported mortality rate of 25-40% (12). Indeed, ischemic events occur as high as 35.4% if antiplatelets are discontinued less than 30 days after placement of a coronary drug eluting stent, and decline to 11.7% if discontinued later but within the rst 6 months, with a reported mortality rate of 25-40% (13) Ticagrelor is an oral, reversibly binding and directly acting P2Y12 receptor antagonist that rapidly peaks within 1.5-3 hours, has a rapid onset of antiplatelet effects, and half-life of 7 to 8 hours.…”