Ideal P2Y12 Inhibitor in Acute Coronary Syndrome: A Review and Current Status

Akshyaya Pradhan, Aashish Tiwari, Giuseppe Caminiti, Chiara Salimei, Saverio Muscoli, Rishi Sethi and Marco Alfonso Perrone
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Akshyaya Pradhan: Department of Cardiology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Aashish Tiwari: Department of Cardiology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Giuseppe Caminiti: Cardiology Rehabilitation Unit, S. Raffaele IRCCS, 00163 Rome, Italy
Chiara Salimei: Department of Cardiology and CardioLab, University of Rome Tor Vergata, 00133 Rome, Italy
Saverio Muscoli: Department of Cardiology and CardioLab, University of Rome Tor Vergata, 00133 Rome, Italy
Rishi Sethi: Department of Cardiology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Marco Alfonso Perrone: Department of Cardiology and CardioLab, University of Rome Tor Vergata, 00133 Rome, Italy

IJERPH, 2022, vol. 19, issue 15, 1-18

Abstract: Dual antiplatelet therapy (DAPT) has remained the cornerstone for management of acute coronary syndrome (ACS) over the years. Clopidogrel has been the quintessential P2Y12 receptor (platelet receptor for Adenosine 5′ diphosphate) inhibitor for the past two decades. With the demonstration of unequivocal superior efficacy of prasugrel/ticagrelor over clopidogrel, guidelines now recommend these agents in priority over clopidogrel in current management of ACS. Cangrelor has revived the interest in injectable antiplatelet therapy too. Albeit the increased efficacy of these newer agents comes at the cost of increased bleeding and this becomes more of a concern when combined with aspirin. Which P2Y12i is superior over another has been intensely debated over last few years after the ISAR-REACT 5 study with inconclusive data. Three novel antiplatelet agents are already in the pipeline for ACS with all of them succeeding in phase II studies. The search for an ideal antiplatelet remains a need of the hour for optimal reduction of ischemic events in ACS.

Keywords: acute coronary syndrome; dual antiplatelet therapy; prasugrel; ticagrelor; cangrelor; P2Y12 inhibitors (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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