P2Y12 receptor inhibitors in patients with non-ST-elevation acute coronary syndrome in the real world: use, patient selection, and outcomes from contemporary European registries

Zeymer, Uwe; Widimský, Petr; Danchin, Nicolás; Lettino, Maddalena; Bardajı́, Alfredo; Barrabés, José A.; Cequier, Ángel; Claeys, Marc J.; Luca, Leonardo De; Dörler, Jakob; Erlinge, David; Erné, Paul; Goldstein, Patrick; Koul, Sasha; Lemesle, Gilles; Lüscher, Thomas F.; Matter, Christian M.; Montalescot, Gilles; Radovanović, Dragana; Sendón, J. López; Toušek, Petr; Weidinger, Franz; Weston, Clive; Zaman, Azfar; Andell, Pontus; Li, Jin; Jukema, J. Wouter

doi:10.1093/ehjcvp/pvw005

Cited by 47 publications

(27 citation statements)

References 11 publications

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“…Although some real-world analyses have shown an association with higher bleeding risk, 29 this observation is not consistent in all registries. [30][31][32] Indeed, the last data coming from Spain showed no differences after matching-cohort analysis. 22 In the light of these results, it might be suggested that there is no such increase in bleeding risk when third-generation P2Y 12 inhibitors are used, particularly in CKD patients.…”

Section: Discussionmentioning

confidence: 94%

Chronic Kidney Disease and Third‐Generation P2Y₁₂ Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year

Tello‐Montoliu

Ruiz-Nodar

Esteve-Pastor

et al. 2018

The Journal of Clinical Pharma

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Chronic kidney disease (CKD) is associated with worse clinical outcomes in patients with acute coronary syndrome. However, they are underrepresented in clinical trials. We aimed to investigate differences in prognosis of acute coronary syndrome patients with and without CKD, focusing on the use of novel P2Y receptor inhibitors. This multicenter registry involved patients with acute coronary syndrome from 3 tertiary institutions. After excluding anticoagulated patients and patients on antiplatelet monotherapy, 1280 patients remained. During 1 year of follow-up, we recorded all major adverse cardiovascular events (composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke), bleeds (Bleeding Academic Research Consortium classification) and deaths. Of 1280 patients, 325 (25.4%) had CKD; 55.5% of non-CKD patients and 22.7% of CKD patients were prescribed novel P2Y inhibitors. During follow-up, CKD patients under novel P2Y inhibitors showed a not statistically significant lower mortality and incidence of thrombotic events than clopidogrel-treated ones. In contrast, non-CKD patients taking novel P2Y inhibitors had better outcomes in terms of major adverse cardiovascular events (4.72 vs 9.41; P = .006), all-cause mortality (1.32 vs 4.24; P = .006), and severe bleeding events (Bleeding Academic Research Consortium 3-5) (0.94 vs 2.82; P = .030), without differences for any bleeding (8.11 vs 8.47; P = .849). Bleeding risk was not increased by using third-generation P2Y inhibitors in either group of patients. In conclusion, the use of third-generation P2Y inhibitors among non-CKD patients was associated with better outcomes. CKD patients receiving third-generation P2Y inhibitors treatment showed no statistically significant lower mortality and thrombotic events. Bleeding risk was not increased with the use of third-generation P2Y inhibitors in either group of patients.

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Section: Discussionmentioning

confidence: 94%

Chronic Kidney Disease and Third‐Generation P2Y₁₂ Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year

Tello‐Montoliu

Ruiz-Nodar

Esteve-Pastor

et al. 2018

The Journal of Clinical Pharma

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“…1), и блокаторы (ингибиторы) P2Y 12 аде-нозиновых рецепторов тромбоцитов (клопидогрел, прасугрел, тикагрелор) [3,4]. Наиболее часто приме-няемыми в настоящее время ААП являются АСК и клопидогрел (рис.…”

Section: основные антитромбоцитарные средстваunclassified

“…В реальной клинической практике частота летальных исходов, ишемических событий, а также частота кровотечений были такими же или даже превышали данные, полученные в ходе ран-домизированных клинических исследований блокаторов P2Y 12 рецепторов. Эти различия объясняются прин-ципами отбора пациентов в рандомизированные кли-нические исследования [4].…”

Section: основные антитромбоцитарные средстваunclassified

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Monitoring of the Effectiveness of Antiplatelet Therapy in Cardiology Practice

Пучиньян

Furman

Malinova

et al. 2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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ВведениеАктивация тромбоцитов -ключевое звено атерот-ромбоза и, следовательно, целого ряда угрожающих жизни состояний, им обусловленных, в том числе, ост-рого коронарного синдрома (ОКС), включающего ин-фаркт миокарда (ИМ) с подъемом или без подъема ST и нестабильную стенокардию. Поэтому подавле-ние/снижение агрегационной активности тромбоци-тов является «краеугольным камнем» терапии и про-филактики атеротромбоза, а антитромбоцитарные (антиагрегантные) препараты (ААП) -обязательный компонент терапии и профилактики целого ряда сер-дечно-сосудистых заболеваний, в основе патогенеза ко-торых лежит атеротромбоз [1,2].Как показано в большом количестве исследова-ний, мета-анализов и систематизированных обзоров, назначение ААП больным ОКС способствует улучшению прогноза пациента независимо от выбранной страте-гии лечения (инвазивной или консервативной). При-менение ААП должно начинаться в как можно более ранние сроки развития ОКС на догоспитальном или ста-ционарном этапах оказания помощи, и должно про-должаться на протяжении всей госпитализации и после выписки из стационара. Контроль эффективности лекарственной терапии является одной из наиболее обсуждаемых проблем в повседневной клинической работе. Появление новых препаратов, методов анализа, стандартов, протоколов ведения, и клинических рекомендаций повышает информацион-ную нагрузку на практикующих врачей, требует существенных затрат сил и времени для самообразования. Цель обзора -в краткой форме помочь практикующим врачам получить необходимые сведения по проблеме контроля антитромбоцитарной терапии. В обзоре воедино све-дены данные современных клинических рекомендаций по антитромбоцитарной терапии у больных ишемической болезнью сердца, приве-дены сведения о существующих подходах к контролю антитромбоцитарной терапии, изложенные в клинических рекомендациях и консен-сусах специалистов. Представлены сведения о наиболее распространенных современных методах контроля эффективности антитромбоци-тарной терапии.Ключевые слова: ишемическая болезнь сердца, антитромбоцитарная терапия, аспирин, клопидогрел, резистентность, контроль. Monitoring of the effectiveness of drug therapy is one of the most debated issues in everyday clinical practice. The emergence of new drugs, methods of analysis, standards, management protocols, and clinical guidelines increases the information load on practitioners and requires a significant investment of time and efforts for self-education. The purpose of the review is to help practitioners in summary form to obtain the necessary information on the issue of control of antiplatelet therapy. The review brings together data from current clinical recommendations on antiplatelet therapy in patients with ischemic heart disease, gives information of existing approaches to control of antiplatelet therapy specified in the guidelines and the consensuses of experts. It presents information on the most common modern methods of monitoring of the antiplatelet therapy effectiveness.

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“…Depending on the clinical setting, the duration of DAPT may range from one month to more than one year [5,6]. Data from major trials and registries have shown that approximately 9%-10% of patients receiving DAPT experienced a thrombotic event within one year, whereas bleeding events occurred in about 2% of patients [3,7,8]. This suggests that individualized antiplatelet regimens, tailoring both DAPT potency as well as duration, might be beneficial in terms of net clinical benefit (i.e., the combination of ischemic and bleeding events).…”

Section: Introductionmentioning

confidence: 99%

Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s

Fontana

Roffi

Reny

2020

JCM

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In the field of antithrombotics, precision medicine is of particular interest, as it may lower the incidence of potentially life-threatening side effects. Indeed, antiplatelet drugs such as P2Y12 inhibitors are one of the most common causes of emergency admissions for drug-related adverse events. The last ten years have seen a continuous debate on whether platelet function tests (PFTs) should be used to tailor antiplatelet drugs to cardiovascular patients. Large-scale randomized studies investigating the escalation of antiplatelet therapies according to the results of PFTs were mostly negative. Potent P2Y12 inhibitors are recommended as a first-line treatment in acute coronary syndrome patients, bringing the bleeding risk at the forefront. De-escalation from prasugrel or ticagrelor to clopidogrel is now considered, with or without the use of a PFT. This review covers recent advances in escalation and de-escalation strategies based on PFTs in various clinical settings. It also describes the main features of the most popular platelet function tests as well as the potential added value of genetic testing. Finally, we detail practical suggestions on how PFTs could be used in clinical practice.

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P2Y12 receptor inhibitors in patients with non-ST-elevation acute coronary syndrome in the real world: use, patient selection, and outcomes from contemporary European registries

Cited by 47 publications

References 11 publications

Chronic Kidney Disease and Third‐Generation P2Y₁₂ Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year

Chronic Kidney Disease and Third‐Generation P2Y₁₂ Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year

Monitoring of the Effectiveness of Antiplatelet Therapy in Cardiology Practice

Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s

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P2Y12 receptor inhibitors in patients with non-ST-elevation acute coronary syndrome in the real world: use, patient selection, and outcomes from contemporary European registries

Cited by 47 publications

References 11 publications

Chronic Kidney Disease and Third‐Generation P2Y12 Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year

Chronic Kidney Disease and Third‐Generation P2Y12 Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year

Monitoring of the Effectiveness of Antiplatelet Therapy in Cardiology Practice

Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s

Contact Info

Product

Resources

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Chronic Kidney Disease and Third‐Generation P2Y₁₂ Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year

Chronic Kidney Disease and Third‐Generation P2Y₁₂ Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year