New P2Y12 inhibitors: what is really new?

2019 ◽  
pp. 32-39
Author(s):  
M. Yu. Gilyarov ◽  
E. V. Konstantinova
Keyword(s):  
P2y12 Inhibitors

Evidence-Based Choice of P2Y12 Inhibitors in End Stage Renal Disease Patients: A Mini-Review

2015 ◽  
Vol 16 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Yassine Bouatou ◽  
Caroline Samer ◽  
Pierre Fontana ◽  
Youssef Daali ◽  
Jules Desmeules
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Evidence Based ◽  
P2y12 Inhibitors ◽  
Stage Renal Disease ◽  
End Stage

Is there Sex-related Outcome Difference According to oral P2Y12 Inhibitors in Patients with Acute Coronary Syndromes? A Systematic Review and Meta-Analysis of 107,126 Patients

2019 ◽  
Vol 17 (2) ◽  
pp. 191-203
Author(s):  
Oliver Brown ◽  
Jennifer Rossington ◽  
Gill Louise Buchanan ◽  
Giuseppe Patti ◽  
Angela Hoye
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndromes ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Bleeding Risk ◽  
Cardiovascular Death ◽  
P2y12 Inhibitors ◽  
Significant Difference ◽  
Coronary Syndromes ◽  
Randomised Controlled

Background and Objectives: The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes. </P><P> Methods: Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel. </P><P> Results: Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men. </P><P> Conclusion: In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.

Myocardial Infarction with and without ST-segment Elevation: a Contemporary Reappraisal of Similarities and Differences

2020 ◽  
Vol 16 ◽  
Author(s):  
Andreas Mitsis ◽  
Felice Gragnano
Keyword(s):  
Myocardial Infarction ◽  
Clinical Presentation ◽  
Standard Of Care ◽  
Epidemiologic Studies ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Similarities And Differences

Abstract:: Understanding the similarities and differences between myocardial infarction with or without ST-segment elevation is an essential step for a proper patients’ management in current practice. Both syndromes are caused by a critical stenosis or a total occlusion of coronary arteries (mostly due to thrombosis on atherosclerotic plaque), and manifest with a similar clinical presentation. Recent epidemiologic studies show that the relative incidence of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) moves in an opposite fashion (decreasing and increasing respectively), with a prognosis that is worse at short-term follow-up for STEMI but comparable at long-term. Current management differs, as for STEMIs an immediate reperfusion is recommended, while for NSTEMIs risk stratification is mandatory in order to stratify patients’ risk, and then decide the timing for coronary angiography. Periprocedural and technical aspects of the interventional management as well antithrombotic medications are for the most similarly implemented in the two types of MI, with routine radial access, DES implant, and novel P2Y12 inhibitors representing the standard of care in both cases. The following review article aims to compare the two types of MI, with and without persistent ST-segment elevation. The main purpose is to explore their similarities and differences and address areas of uncertainty with regards to clinical presentation, therapeutic management, and prognosis. The identification of high-risk NSTEMI patients is important as they may require an individualised approach that can substantially overlap with current STEMI recommendations and their mortality remains high if their management is delayed.

PCV26 ALL-Cause and Bleeding Costs of Patients Initiating P2Y12 Inhibitors, Fxa Inhibitors, and Dabigatran

2021 ◽  
Vol 24 ◽  
pp. S71
Author(s):  
A. Kong ◽  
J. Lee ◽  
K. Evans ◽  
C. Morrow ◽  
J. Erickson ◽  
...  
Keyword(s):  
P2y12 Inhibitors

scholarly journals 34 Next generation P2Y12 inhibitors improve survival in ACS: an analysis from the british cardiovascular intervention society database

2021 ◽  
Author(s):  
Fahmida Mannan ◽  
Sushant Saluja ◽  
Hussain Contractor ◽  
Nik Abidin ◽  
Alan Fitchet ◽  
...  
Keyword(s):  
Next Generation ◽  
P2y12 Inhibitors ◽  
Cardiovascular Intervention

P2Y12 inhibitors in neuroendovascular surgery: An opportunity for precision medicine

2021 ◽  
pp. 159101992199139
Author(s):  
Axel Rosengart ◽  
Malie K Collins ◽  
Philipp Hendrix ◽  
Ryley Uber ◽  
Melissa Sartori ◽  
...  
Keyword(s):  
Adverse Events ◽  
Precision Medicine ◽  
Point Of Care ◽  
Indirect Evidence ◽  
Cost Benefit ◽  
Interventional Cardiology ◽  
Platelet Inhibition ◽  
Response Monitoring ◽  
P2y12 Inhibitor ◽  
P2y12 Inhibitors

Introduction Dual antiplatelet therapy (DAPT), primarily the combination of aspirin with a P2Y12 inhibitor, in patients undergoing intravascular stent or flow diverter placement remains the primary strategy to reduce device-related thromboembolic complications. However, selection, timing, and dosing of DAPT is critical and can be challenging given the existing significant inter- and intraindividual response variations to P2Y12 inhibitors. Methods Assessment of indexed, peer-reviewed literature from 2000 to 2020 in interventional cardiology and neuroendovascular therapeutics with critical, peer-reviewed appraisal and extraction of evidence and strategies to utilize DAPT in cardio- and neurovascular patients with endoluminal devices. Results Both geno- and phenotyping for DAPT are rapidly and conveniently available as point-of-care testing at a favorable cost-benefit ratio. Furthermore, systematic inclusion of a quantifying clinical risk score combined with an operator-linked, technical risk assessment for potential adverse events allows a more precise and individualized approach to new P2Y12 inhibitor therapy. Conclusions The latest evidence, primarily obtained from cardiovascular intervention trials, supports that combining patient pharmacogenetics with drug response monitoring, as part of an individually tailored, precision medicine approach, is both predictive and cost-effective in achieving and maintaining individual target platelet inhibition levels. Indirect evidence supports that this gain in optimizing drug responses translates to reducing main adverse events and overall treatment costs in patients undergoing DAPT after intracranial stent or flow diverting treatment.

scholarly journals Platelet aggregation inhibitor prescription for newly diagnosed peripheral arterial disease in the Netherlands: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041715
Author(s):  
Aarent RT Brand ◽  
Eline Houben ◽  
Irene D Bezemer ◽  
Frank L J Visseren ◽  
Michiel L Bots ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
The Netherlands ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Free Text ◽  
Newly Diagnosed ◽  
Patient Journey ◽  
P2y12 Inhibitors ◽  
Peripheral Arterial

ObjectivesPharmacological treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription, but there are little data on the actual prescription practices. Our study provides insight into the prescription of medication among patients with PAD in the Netherlands and reports a ‘real-world’ patient journey through primary and secondary care.DesignWe conducted a cohort study among patients newly diagnosed with PAD between 2010 and 2014.SettingData were obtained from the PHARMO Database Network, a population-based network of electronic pharmacy, primary and secondary healthcare setting records in the Netherlands. The source population for this study comprised almost 1 million individuals.Participants‘Newly diagnosed’ was defined as a recorded International Classification of Primary Care code for PAD, a PAD-specific WCIA examination code or a diagnosis recorded as free text episode in the general practitioner records with no previous PAD diagnosis record and no prescription of P2Y12 inhibitors or aspirin the preceding year. The patient journey was defined by at least 1 year of database history and follow-up relative to the index date.ResultsBetween 2010 and 2014, we identified 3677 newly diagnosed patients with PAD. Most patients (91%) were diagnosed in primary care. Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vitamin K antagonist or direct oral anticoagulant). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12 inhibitors (2.5% of patients). Dual APT combining aspirin with a P2Y12 inhibitor was dispensed to 8.5% of the study population.ConclusionHalf of all patients with newly diagnosed PAD are not treated conforming to (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy. Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted.

scholarly journals Development of 1- and 5-year outcomes between 2006 and 2018 in patients with uncomplicated ST-elevation myocardial infarctions and successful percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Schmucker ◽  
A Fach ◽  
R Osteresch ◽  
T Retzlaff ◽  
D Garstka ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Public Institution ◽  
Funding Source ◽  
P2y12 Inhibitors ◽  
Percutaneous Coronary ◽  
Table Analysis ◽  
St Elevation ◽  
Few Data ◽  
Event Rates

Abstract Introduction While modern P2Y12-inhibitors and drug eluting stents (DES) have changed therapeutic options in patients with ST-elevation mycoardial infarctions (STEMI) during the last decade, there is few data on their impact in real world registries. Aim of the present study was to analyze changes in mortality and major adverse cardiac and cererobrovascular event rates (MACCE: death, reinfarction,stroke) during the last 13 years in patients with uncomplicated STEMI after successful percutaneous coronary intervention (PCI). Methods All consecutive STEMI-patients, admitted between 2006 and 2018 and successfully treated with PCI (TIMI flow ≥2) in a large German heart center entered analysis. To reduce confounding pts. with STEMI complicated by heart failure and pts. &gt;70 yrs. of age were excluded. Results A STEMI-cohort of 5016 pts. was analysed, with a mean age of 55.9±8 yrs., 19% females, 16% diabetics and 59% smokers. At the beginning of the study period (2006) no patient was treated with ticagrelor/prasugrel and only 5% had a DES implanted. In 2018 92% were treated with prasugrel or ticagrelor and 96% with a DES. The reduction in 1-year-mortality during the study period was not significant: 2006–11: 3.4%, 2012–19: 3.1%, p=0.4, however the reduction in 1-year-MACCE was: 2006–11: 8.3%, 2012–18: 5.7%, p&lt;0.01. This could mainly be attributed to a reduction in reinfarctions: 2006–11: 4.9%, 2012–18: 2.8%, p&lt;0.01. Subgroup analysis revealed that with the exception of diabetics all subgroups showed a significant decline in MACCE-rates during the study period. It was more pronounced in women, non-smokers and patients with a high socioeconomic status (SES) (Table). Analysis of 5-year-data revealed a significant reduction in both 5-year-mortality (2006–09: 9.1%, 2010–13: 6.8%, p&lt;0.01) and 5-year-MACCE-rates: 2006–09: 19.3%, 2010–13: 14.5%, p&lt;0.01. Conclusions This analysis of registry data over a study period of 13 years reveals, that for patients with uncomplicated STEMI and successful PCI a significantly better 1- and 5-year-outcome could be achieved during the last years. This improvement of prognosis was more pronounced in specific subgroups, such as women, non-diabetics and patients with higher SES. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Stiftung Bremer Herzen, Gesundheit Nord

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