Antiplatelet therapy with aspirin and P2Y12
inhibitors is the cornerstone of medical treatment in patients after PCI, which prevents ischemic events with increased risk of bleeding.
Patients in either of these categories metabolize enough clopidogrel into the active form to get full benefit from the drug and derive no additional efficacy benefit from switching to another P2Y12
inhibitor, such as ticagrelor or prasugrel (Effient)--drugs unaffected by metabolizer status.
They were 24% less likely to undergo PCI, 18% less likely to receive P2Y12
antagonists and 13% less likely to receive statins.
The comprehensive new version reflects current best practices for using aspirin combined with P2Y12
receptor inhibitors clopidogrel, prasugrel or ticagrelor, and includes a review of 11 studies of patients treated with coronary stent implantation done predominately with drug-eluting stents to assess the risks and benefits of shorter-versus longer-duration dual antiplatelet therapy.
Dual antiplatelet therapy (a P2Y12
receptor antagonist and aspirin) should be used for as long as one year after an ACS and may have benefits beyond this period.
4,14,15) The TEG PlateletMapping assay enables platelet function to be assessed through the P2Y12
or thromboxane pathway.
receptors in spinal microglia are required for neuropathic pain after peripheral nerve injury.
In this review we discuss genetic variants that affect drug response to 3 classes of cardiovascular drugs: statins, platelet P2Y12
inhibitors, and anticoagulants.
Smokers also have higher P2Y12
expression in platelet lysates than nonsmokers.
Main features of P2Y12
receptor inhibitors (1) Clopidogrel Prasugrel Chemical class Thienopyridine Thienopyridine Administration Oral Oral Dose 300-600 mg bolus, 60 mg bolus, 75 mg/day 10 mg/day Receptor inhibition Irreversible Irreversible Activation Prodrug Prodrug Onset of action 2-6 h 30 min Duration of effect 3-10 days 7-10 days Withdrawal before surgery 5 days 7 days Ticagrelor Cangrelor Chemical class Cyclopentyl-triazolo Stabilized ATP -pyrimidine analogue Administration Oral Intravenous Dose 180 mg bolus, 30 mcg/kg bolus, 90 mg x 2 /day 4 mcg/kg/min inf.
Other agents, such as the thienopyridines, work to inhibit platelet activation and aggregation, specifically by inhibiting the P2Y12
adenosine diphosphate (ADP) receptor on platelets.
The most frequently missed were dietary advice, stop smoking advice and the prescription of a type of anticlotting drug known as P2Y12
inhibitors, such as clopidogrel.