Coronary Artery Disease
The promise of effective P2Y12 platelet receptor pretreatment: Not crushed yet
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 P2Y12 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 P2Y12 inhibition at no incremental risk and cost.
CONFLICT OF INTEREST
Nothing to report.
