Optimising antiplatelet therapy in acute coronary syndromes
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 12
Abstract
Platelet mediated thrombosis plays central role in pathogenesis of acute coronary syndromes (ACS). The main receptors acting in this process: P2Y12 and GPIIb/IIIa, are major targets of pharmacotherapy. Inhibition of another platelet receptor PAR-1 is under investigation. Addition of clopidogrel, P2Y12 inhibitor, to aspirin (ASA) reduces major adverse cardiovascular events in wide range of patients, but there is a group of hyporesponders with high on treatment platelet reactivity and worse thrombotic outcomes, and also hyperresponders with higher bleeding risk. These groups might be identified not only by clinical factors, but also genetic tests and platelet reactivity assays. Antiplatelet therapy may be optimized by using higher doses of clopidogrel, or new more potent P2Y12 inhibitors: prasugrel, ticagrelor and elinogrel. Triple antiplatelet therapy including GPIIb/IIIa inhibitors: abciximab, tirofiban or eptifibatide, is recommended in ACS patients determined to be at elevated risk for ischemic events, but optimal timing of therapy and selection of GPIIb/IIIa inhibitor is still discussed. The challenge of future ACS pharmacotherapy is to find optimal window of platelet inhibition, balanced between efficacy and safety with tailored dual or triple antiplatelet therapy.
Authors and Affiliations
Bogumił Ramotowski, Andrzej Budaj
Keywords
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