Switching Between P2Y 12 Antagonists - From Bench to Bedside

Vascul Pharmacol. 2019 Apr;115:1-12. doi: 10.1016/j.vph.2019.01.003. Epub 2019 Jan 24.

Abstract

Platelet P2Y12 receptors play a key role in platelet activation and thrombus formation. Accordingly, P2Y12 receptor antagonists are the cornerstone of secondary prevention of atherothrombotic events in patients undergoing percutaneous coronary intervention (PCI). The availability of different oral P2Y12 antagonists (clopidogrel, prasugrel, ticagrelor) along with the introduction of the first intravenous P2Y12 antagonist cangrelor offer an opportunity to individualize antiplatelet therapy according to the changing clinical setting. The recent International Expert Consensus provided the first recommendations on switching between the P2Y12 antagonists. While the consensus greatly helps to guide switching between P2Y12 antagonists, a number of controversial clinical scenarios remain where the evidence regarding the optimal switch strategy is scarce. In such clinical scenarios, understanding of the (i) pharmacological properties of P2Y12 antagonists, (ii) recent evidence from pharmacodynamics studies, clinical trials and registries, and (iii) factors affecting the efficacy and safety of the P2Y12 antagonists, all summarized below, are crucial to choose the optimal switch strategy.

Keywords: Acute coronary syndrome; Antiplatelet drugs; Myocardial infarction; P2Y12 receptor; Switch.

Publication types

  • Review

MeSH terms

  • Animals
  • Clinical Decision-Making
  • Coronary Disease / blood
  • Coronary Disease / diagnosis
  • Coronary Disease / therapy*
  • Decision Support Techniques
  • Decision Trees
  • Drug Administration Schedule
  • Drug Substitution*
  • Humans
  • Percutaneous Coronary Intervention* / adverse effects
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Aggregation Inhibitors / pharmacokinetics
  • Practice Guidelines as Topic
  • Purinergic P2Y Receptor Antagonists / administration & dosage*
  • Purinergic P2Y Receptor Antagonists / adverse effects
  • Purinergic P2Y Receptor Antagonists / pharmacokinetics
  • Risk Factors
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists