This small study tested the pharmacodynamic effects of several antiplatelet agents. It concluded that tirofiban (Aggrastat) provides “more potent and consistent” inhibition of platelet aggregation compared with cangrelor in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty. Thirty minutes after the initiation of treatment, there was a nearly threefold difference between tirofiban and cangrelor…
Are Non-Culprit Lesions Really Innocent?
In recent times, a lot has been said about reducing the duration or intensity of antiplatelet therapy following percutaneous coronary intervention (PCI) regardless initial indications. All evidence in support of these arguments might be failing to show the risk of non-culprit lesion events in patients with acute coronary syndromes (ACS). Potent and prolonged antithrombotic therapies…
ESC 2019 | ISAR-REACT 5 | Which Is Better in ACS, Prasugrel or Ticagrelor?
Courtesy of Dr. Carlos Fava. The benefit of dual antiplatelet therapy in acute coronary syndromes (ACS) has been proven long ago, and both prasugrel and ticagrelor have offered best results than clopidogrel. However, nowadays, it is unclear which of them is superior in the long term, taking into account the fact that one starts to…
What is the best antiplatelet in PCI to vein grafts?
Courtesy of Dr. Carlos Fava. PCI to saphenous vein grafts is one the greatest challenges these days because, as opposed to native arteries, they present important thrombolytic material, diffuse and long lesions, and abundant macrophage and inflammatory cells, which makes the procedure more complex. At present, we have not yet agreed on the best antiplatelet…
Elderly Patients with ACS: Clopidogrel or Reduced-Dose Prasugrel?
Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome (ACS), and display higher platelet reactivity under clopidogrel when compared to younger patients. A 5-mg dose of prasugrel would provide more predictable platelet inhibition than clopidogrel in elderly populations, without the risk of bleeding entailed by the full…
What Is the Best Antiplatelet Therapy in Primary Angioplasty at 12 Months?
Both prasugrel and ticagrelor showed superiority in terms of efficacy, reducing the number of major cardiovascular events at the expense of increased bleeding. This is an affordable cost, and the net clinical benefit supports these new antiplatelet therapies. The one-year follow-up of the PRAGUE-18 study focused on a comparison of efficacy and safety between prasugrel…
Clinical and Economic Costs Compete in the De-Escalation of Antiplatelet Therapy
Patients undergoing primary angioplasty for ST-segment elevation acute myocardial infarction have similar clinical outcomes at 1 year regardless of whether they are treated with ticagrelor or prasugrel, according the PRAGUE-18 study. This new substudy adds an interesting detail: patients who switched from prasugrel and ticagrelor to clopidogrel, citing economic reasons for the “de-escalation” of therapy, were…
When and How to Switch Dual Antiplatelet Therapies
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is the treatment of choice for patients with acute coronary syndrome who undergo coronary angioplasty. Different oral P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) present different characteristics as regards efficacy, risk for bleeding, cost, and timing of administration. In this sense, physicians frequently switch among drugs according to…
TOPIC: Benefits of Switching Dual Antiplatelet Therapy in Patients with ACS
Newer P2Y12 blockers are the front-line treatment and dual antiplatelet therapy is indicated for 1 year after acute coronary syndrome (ACS). Both prasugrel and ticagrelor offer more ischemic benefit than clopidogrel during the initial phase; however, bleeding complications could increase in the long term. The objective of this study was to assess the safety and efficacy…
Ticagrelor vs. Prasugel: Similar Safety and Efficacy in Primary Angioplasty
No randomized head-to-head study comparing the efficacy and safety of ticagrelor and prasugrel has been carried out in the last 7 years since these newer P2Y12 inhibitors first showed a higher efficacy relative to clopidogrel. This study was designed to compare the efficacy and safety of prasugrel and ticagrelor in patients with acute myocardial infarction…