Current Evidence on Platelet P2Y12 Receptor Inhibitors: Is There Still a Role for Clopidogrel in 2015?

Abstract Antiplatelets play a significant role in the management of patients with coronary disease. Novel inhibitors of the platelet P2Y12 receptor have more rapid, potent, and consistent inhibitory effect on platelets compared with clopidogrel. Evidence from large clinical studies have defined popu...

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Bibliographic Details
Published in:Canadian journal of cardiology 2015-12, Vol.31 (12), p.1481-1484
Main Authors: Qutub, Mohammed A., MD, FRCPC, FACP, Chong, Aun-Yeong, MBBS, MRCP(UK), MD, So, Derek Y.F., MD, FRCPC, FACC
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - drug therapy
Adenosine - adverse effects
Adenosine - analogs & derivatives
Adenosine - therapeutic use
Algorithms
Angioplasty, Balloon, Coronary
Cardiovascular
Humans
Myocardial Infarction - drug therapy
Platelet Aggregation Inhibitors - adverse effects
Platelet Aggregation Inhibitors - therapeutic use
Prasugrel Hydrochloride - adverse effects
Prasugrel Hydrochloride - therapeutic use
Precision Medicine
Purinergic P2Y Receptor Antagonists - adverse effects
Purinergic P2Y Receptor Antagonists - therapeutic use
Ticlopidine - adverse effects
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
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Summary:Abstract Antiplatelets play a significant role in the management of patients with coronary disease. Novel inhibitors of the platelet P2Y12 receptor have more rapid, potent, and consistent inhibitory effect on platelets compared with clopidogrel. Evidence from large clinical studies have defined populations in which novel agents are superior to clopidogrel. Ticagrelor or prasugrel in addition to aspirin should be used preferentially for patients with ST-elevation myocardial infarction because of significant anti-ischemic benefits. In patients with non-ST segment elevation acute coronary syndromes, ticagrelor has proven superiority over clopidogrel whether or not an invasive strategy is adopted, and prasugrel has been shown to be beneficial when started at the time of percutaneous coronary intervention. Of note, neither prasugrel nor ticagrelor have been studied in patients who underwent percutaneous coronary intervention for stable coronary disease or those who required ‘triple therapy.’ In these situations, clopidogrel should remain the default until further data are available. Prolonged use of clopidogrel in patients with drug-eluting stents beyond 12 months is emerging as a novel indication for the agent.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2015.04.019