Pretreatment with P2Y12 Receptor Inhibitors in Acute Coronary Syndromes—Is the Current Standpoint of ESC Experts Sufficiently Supported?

Excessive platelet reactivity plays a pivotal role in the pathogenesis of acute myocardial infarction. Today, the vast majority of patients presenting with acute coronary syndromes qualify for invasive treatment strategy and thus require fast and efficient platelet inhibition. Since 2008, in cases o...

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Bibliographic Details
Published in:Journal of clinical medicine 2023-03, Vol.12 (6), p.2374
Main Authors: Niezgoda, Piotr, Ostrowska, Małgorzata, Adamski, Piotr, Gajda, Robert, Kubica, Jacek
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Blood platelets
Clinical medicine
Clinical outcomes
Coronary vessels
Glycoproteins
Heart attacks
Hemodynamics
Ischemia
Medical imaging
Review
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Summary:Excessive platelet reactivity plays a pivotal role in the pathogenesis of acute myocardial infarction. Today, the vast majority of patients presenting with acute coronary syndromes qualify for invasive treatment strategy and thus require fast and efficient platelet inhibition. Since 2008, in cases of ST-elevation myocardial infarction, the European Society of Cardiology guidelines have recommended pretreatment with a P2Y12 inhibitor. This approach has become the standard of care in the majority of centers worldwide. Nevertheless, the latest guidelines for the management of patients presenting with acute coronary syndrome without persisting ST-elevation preclude routine pretreatment with the P2Y12 receptor inhibitor. Those who oppose pretreatment support their stance with trials failing to prove the benefits of this strategy at the cost of an increased risk of major bleeding, especially in individuals inappropriately diagnosed with an acute coronary syndrome, thus having no indication for platelet inhibition. However, adequate platelet inhibition requires even up to several hours after application of a loading dose of P2Y12 receptor inhibitors. Omission of data from pharmacokinetic and pharmacodynamic studies in the absence of data from clinical studies makes generalization of the pretreatment recommendations difficult to accept. We aimed to review the scientific evidence supporting the current recommendations regarding pretreatment with P2Y12 inhibitors.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm12062374