Preview

Rational Pharmacotherapy in Cardiology

Advanced search

The Use of Dual Antiplatelet Therapy in Acute Coronary Syndrome and Percutaneous Coronary Intervention

https://doi.org/10.20996/1819-6446-2019-15-2-277-281

Full Text:

Abstract

Currently, cardiovascular diseases play a leading role in the structure of morbidity. It is expected that by 2020 in developing countries cardiovascular diseases will take the leading position in the structure of mortality. Among the diseases of the cardiovascular system the leading position is occupied by coronary heart disease. One of the manifestations of coronary heart disease is acute coronary syndrome. In addition to endovascular treatment, dual antiplatelet therapy plays a key role in the treatment and prevention of acute coronary syndrome. Double antiplatelet therapy is a combination of acetylsalicylic acid and platelet P2Y12 receptor inhibitors. One of the first drugs from the group of P2Y12 receptor inhibitors is clopidogrel. It has been proven that the use of clopidogrel to date not always reduces the risk of development of thrombotic complications, of particular interest are the representatives of the "new" platelet P2Y12 receptor inhibitors. Such platelet P2Y12-receptor inhibitors include ticagrelor and prasugrel. The article considers in detail the issue of efficiency and safety of prasugrel use. The results of the studies allow to distinguish this drug as an effective inhibitor of P2Y12 platelet receptors in patients with acute coronary syndrome who have undergone percutaneous coronary intervention. Considering the pronounced antiplatelet effect of the drug, it should not be prescribed to patients with stroke and a history of transient ischemic attack. Prasugrel also should not be prescribed in a full dose to patients over 75 years old and patients weighing up to 60 kg. These studies showed that when the recommendations are followed, prasugrel demonstrates good results in reducing the frequency of cardiovascular events in patients with acute coronary syndrome and percutaneous coronary intervention. Separately, we can distinguish the effect of prasugrel on the development of stent thrombosis. So, in patients that underwent stenting, the use of prasugrel significantly reduced the frequency of confirmed stent thrombosis, which can also affect the development of undesirable cardiovascular events.

About the Authors

A. S. Tereshchenko
National Medical Research Center of Cardiology
Russian Federation

Andrei S. Tereshchenko - MD, PhD, Researcher, Department of Endovascular Methods of Diagnosis and Treatment.

119991, Москва, Абрикосовский пер., 2



E. V. Merkulov
National Medical Research Center of Cardiology
Russian Federation

Evgeny V. Merkulov - MD, PhD, Senior Researcher, Head of the 1 st Department of Endovascular Methods of Diagnosis and Treatment

119991, Москва, Абрикосовский пер., 2



A. N. Samko
National Medical Research Center of Cardiology
Russian Federation

Anatoly N. Samko - MD, PhD, Professor, Scientific Adviser of the 1st Department of Endovascular Methods of Diagnosis and Treatment.

119991, Москва, Абрикосовский пер., 2



S. A. Abugov
B.V. Petrovsky Russian Scientific Center of Surgery
Russian Federation

Sergey A. Abugov - MD, PhD, Professor, Head of the Department of X-ray Surgery and Arrhythmology.

Abrikosovskiy per. 2, Moscow, 119991



References

1. Bubnova S.S., Usacheva E.V., Zamahina O.V. Changes in the incidence of myocardial infarction in the regions of the Russian Federation for the 11 -year period (2002-201 2). Social'nye aspekty zdorov'ja naselenija. 2014; 6(40): 1 -14. (In Russ.).

2. Denisov I.N., Lesnjak O.M. General medical practice: national leadership. Volume I. Moscow: GEOTAR-Media; 2013 (In Russ.)

3. Aronov D. M., Lupanov V.P. Some aspects of the pathogenesis of atherosclerosis.. 2011; 1: 48- 56.

4. Okrugin S.A., Kuzheleva E.A., Garganeeva A.A.. WHO program "Register of acute myocardial infarction": epidemiological monitoring of acute coronary accidents. 2018;7(1 ):76-83.

5. O'Gara P.T., Kushner FG., Ascheim D.D. et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation. 2013;1 27:362-425. doi:10.1016/j.jacc.2012.11.019.

6. Andreev D.A. The significance of platelet functional activity testing in the prevention of cardiovascular complications in patients receiving antiplatelet therapy. Rational Pharmacotherapy in Cardiology. 2014;10(6):679-87 (In Russ.) doi: 10.20996/1819-6446-2014-10-6-679-687.

7. Hansson E.C., Jideus L., Aberg B. et al. Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study. Eur Heart J. 2016; 37(2):189-97. doi:10.1093/eurheartj/ehv381.

8. Angiolillo D.J., Fabiana D.R., Bhatt R. et al. International expert consensus on switching platelet P2Y12 receptor-inhibiting therapies. Circulation. 2017;136(20):1955-75. doi:10.1161/CIRCULATION-AHA.117.031164.

9. Aradi D. Bleeding and stent thrombosis on P2Y12-inhibitors: collaborative analysis on the role of platelet reactivity for risk stratification after percutaneous coronary intervention. Eur Heart J. 2015 ;36(27) :1762-71. doi:10.1093/eurheartj/ehv104.

10. Rodionov A.V., Ajnetdinova D.H., Sulimov VA. Dual antiplatelet therapy in patients with acute coronary syndrome. Cardiovascular Therapy and Prevention. 2011; 10(5): 87-91. (In Russ.)

11. Farag M., Gorog D.A. Platelet Function Testing: A Role for Personalised Therapy in Coronary Disease. Curr Pharm Des. 2017;23(9):1 31 5-27. doi:10.2147/DDDTS68391.

12. Ibanez B., James S., Agewall S., et al. ESC Scientific Document Group, 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):1 19-77. doi:10.1093/eurheartj/ehx393.

13. . Levine G.N., Bates E.R., Bittl J.A., et al. ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American college of Cardiology. American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2016;68:1 082-1 1 5. doi:10.1016/j.jacc.2016.03.513.

14. Gosling R., Yazdani M., Parviz Y, et al. Comparison of P2Yt2 inhibitors for mortality and stent thrombosis in patients with acute coronary syndromes: Single center study of 10 793 consecutive 'real-world' patients. Platelets. 2017;28(8):767-73. doi:10.1080/09537104.2017.1280601.

15. Alexopoulos D., Galati A., Xanthopoulou I., et al. Ticagrelor versus prasugrel in acute coronary syndrome patients with high on-clopidogrel platelet reactivity following percutaneous coronary intervention: a pharmacodynamic study J Am Coll Cardiol. 2012;17(60):193-9. doi:10.1016/j.jacc.2012.03.050.

16. Lindholm D., Varenhorst C., Cannon C.P., et al. Ticagrelor vs. clopidogrel in patients with non-ST-el-evation acute coronary syndrome with or without revascularization: results from the PLATO trial. Eur Heart J. 2014;35:2083-93. doi: 10.1093/eurheartj/ehu160.

17. Shahmatova O.O., Komarov A.L. Prasugrel in the treatment of patients with acute coronary syndrome and percutaneous coronary intervention: current state of the problem. Aterotromboz. 2018;1: 52-66 (In Russ.)

18. Angiolillo D.J., Jakubowski J.A., Ferreiro J.L., et al. Impaired responsiveness to the platelet P2Y12 receptor antagonist clopidogrel in patients with type 2 diabetes and coronary artery disease. J Am Coll Cardiol. 2014;64:1005-14. doi:10.1016/j.jacc.2014.06.1170.

19. Abaci A. The use of prasugrel in STEMI and NSTEMI: TRITON TIMI 38 study and subgroup analyses. Turk Kardiyol Dern Ars. 2015;43 Suppl 2:1-6.

20. Husted S., Boersma E. Case study: Ticagrelor in PLATO and Prasugrel in TRITON-TIMI 38 and TRIL-OGY-ACS trials in patients with acute coronary syndromes. Am J Ther. 2016;23:1 876-89.doi:10.1097/MJT.0000000000000237.

21. Sakurai R., Burazor I., Bonneau H.N., et al. Head-to-head comparison of prasugrel versus ticagrelor in patients undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials. J Interv Cardiol. 2017;5:457-64. doi:10.1186/s40360-017-0189-7.

22. MichelsonA.D., FrelingerA., Braunwald E., et al. Pharmacodynamic assessment of platelet inhibition by prasugrel vs. clopidogrel in the TRITON-TIMI 38 trial. Eur Heart J. 2009;30:1 753-63. doi:10.1093/eurheartj/ehp159.

23. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011 ;32(23):2999-3054. doi:10.1093/eurheartj/ehr236.

24. Stephen D. Wiviott, M.D., Braunwald E., et al. TRITON-TIMI 38 Investigators. Prasugrel versus Clopi-dogrel in Patients with Acute Coronary Syndromes. N Engl J Med. 2007; 357:2001-15. doi:10.1056/NEJMoa0706482.

25. Larmore C., Effron M.B., MolifeC. et al. "Real-World" Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States. Catheter Cardiovasc Interv, 2016;88(4):535-44. doi:10.1002/ccd.26279.

26. Olier I., Sirker A., Hildick-Smith D.J.R., et al. Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention. Heart. 2018;1 04(20):1 683-90. doi:10.1136/heartjnl-2017-312366.


For citation:


Tereshchenko A.S., Merkulov E.V., Samko A.N., Abugov S.A. The Use of Dual Antiplatelet Therapy in Acute Coronary Syndrome and Percutaneous Coronary Intervention. Rational Pharmacotherapy in Cardiology. 2019;15(2):277-281. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-2-277-281

Views: 106


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)