Bridging the gap: Current and future insights for improving suboptimal platelet inhibition in STEMI

Int J Cardiol. 2021 Apr 1:328:40-45. doi: 10.1016/j.ijcard.2020.11.042. Epub 2020 Nov 23.


Antiplatelet therapy is one of the cornerstones in the acute treatment of patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI). However, hemodynamic changes and delayed intestinal absorption of P2Y12 inhibitors leads to a delay in the onset of antiplatelet effects resulting in a gap of platelet inhibition. Several strategies have been proposed to bridge this gap, such as pre-hospital administration of antiplatelet therapy, higher loading doses of P2Y12 inhibitors, crushing or chewing tablets, subcutaneous or intravenous administration of platelet inhibitors, or use of pain relievers alternative to opioids that do not delay intestinal absorption of oral platelet inhibitors. These strategies may improve platelet inhibition with the goal of optimizing clinical outcomes in the acute phase of STEMI. In this review we present current and future insights for bridging the gap in platelet inhibition in STEMI patients undergoing primary PCI.

Keywords: Antiplatelet therapy; Glycoprotein IIb/IIIa inhibitors; P2Y(12) inhibitors; STEMI.

Publication types

  • Review

MeSH terms

  • Blood Platelets
  • Humans
  • Percutaneous Coronary Intervention*
  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists
  • ST Elevation Myocardial Infarction* / diagnosis
  • ST Elevation Myocardial Infarction* / drug therapy
  • ST Elevation Myocardial Infarction* / surgery
  • Treatment Outcome


  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists