Pretreatment With P2Y ₁₂ Inhibitors in Non–ST-Segment–Elevation Acute Coronary Syndrome Is Clinically Justified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

“…Poważne krwawienia wg klasyfikacji TIMI w 7. dobie były istotnie częstsze w grupie chorych, których poddano wczesnemu leczeniu prasugrelem [wczesne leczenie 2,6% vs. bez wczesnego leczenia 1,4%; HR 1,90 (95% CI 1,19-3,02); p = 0,006]. Argumenty za i przeciw wczesnemu leczeniu inhibitorami P2Y 12 w NSTE-ACS są wciąż przedmiotem dyskusji, a kwestia ta budzi kontrowersje [165,166]. Ze względu na fakt, że jak dotąd nie ustalono optymalnego czasu zastosowania tikagreloru lub klopidogrelu u pacjentów z NSTE--ACS, którzy zostali zakwalifikowani do strategii inwazyjnej, nie można formułować żadnych zaleceń dotyczących kwestii ewentualnego wczesnego podawania tych leków.…”

Switching P2Y12-receptor inhibitors in patients with coronary artery disease

“…9 Despite the controversies surrounding the benefit of early initiation of P2Y 12 -inhibiting therapy, particularly before the coronary anatomy of patients undergoing an invasive procedure is known, pretreatment with clopidogrel has been part of standard-of-care algorithms in many centres for the past decade. 5,6,[10][11][12] Although the prevalence of pretreatment with P2Y 12 -receptor inhibitors varies, and with this approach being more common in Europe than in the USA, how to switch to a new-generation P2Y 12 -receptor inhibitor has been a conundrum for many clinicians. 12,13 Other challenges that clinicians currently face include how to switch from a novel P2Y 12 -receptor inhibitor to clopidogrel, as well as how to switch between different novel P2Y 12 -receptor inhibitors.…”

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

“…35 In patients with ACS, ticagrelor (180 mg loading dose, 90 mg twice daily) on top of aspirin c is recommended, regardless of initial treatment strategy, including patients pre-treated with clopidogrel (which should be discontinued when ticagrelor is commenced) unless there are contraindications. 20 …”