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Contemporary Antiplatelet Pharmacotherapy in the Management of Acute Coronary Syndromes

  • Daniel R. Mangels
  • Ashwin Nathan
  • Sony Tuteja
  • Jay Giri
  • Taisei Kobayashi
Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
  • 160 Downloads
Part of the following topical collections:
  1. Topical Collection on Coronary Artery Disease

Abstract

Purpose of review

Antiplatelet therapies are pivotal treatments in the management of acute coronary syndrome (ACS) with or without revascularization. In recent years, the use of P2Y12 antagonists prior to catheterization, so-called pretreatment, has been questioned, particularly in patients who may be at higher bleeding risks. The purpose of this review was to evaluate the current literature on contemporary and novel antiplatelet therapy in the pretreatment and treatment of ACS.

Recent findings

The P2Y12 receptor antagonists are associated with substantial reductions in morbidity and mortality for all types of ACS but only clopidogrel and ticagrelor have sufficient evidence for use in the pretreatment setting. The data regarding prasugrel support the use in patients undergoing percutaneous intervention (PCI). The glycoprotein IIa/IIIb antagonists are the most optimal for use in high-risk ACS as an adjuvant therapy during and after PCI.

Summary

In summary, although all P2Y12 antagonists have morbidity- and mortality-reducing effects in ACS, only clopidogrel and ticagrelor have sufficient evidence in the pretreatment setting. Newer antiplatelet therapies, most notably the protease-activated receptor 1 antagonists, are evolving and promising but are associated with greater bleeding risks.

Keywords

Antiplatelet P2Y12 Pretreatment ACS Coronary Ticagrelor 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Daniel R. Mangels
    • 1
  • Ashwin Nathan
    • 1
  • Sony Tuteja
    • 1
  • Jay Giri
    • 1
  • Taisei Kobayashi
    • 1
  1. 1.Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA

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