Platelet Inhibition in Acute Coronary Syndrome and Percutaneous Coronary Intervention: Insights from the Past and Present

Abstract Platelet activation and aggregation have a pivotal role in arterial thrombosis and in the pathogenesis of both acute coronary syndromes (ACS) and in the thrombotic complications that occur in patients undergoing percutaneous coronary intervention (PCI). The past 30 years has seen the progre...

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Vydáno v:Thrombosis and haemostasis Ročník 120; číslo 4; s. 565 - 578
Hlavní autoři: Gorog, Diana A., Geisler, Tobias
Médium: Journal Article
Jazyk:angličtina
Vydáno: Stuttgart · New York Georg Thieme Verlag KG 01.04.2020
Témata:
Acute Coronary Syndrome - therapy
Animals
Hemorrhage - etiology
Hemorrhage - prevention & control
Humans
Molecular Targeted Therapy
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors - therapeutic use
Platelet Function Tests
Postoperative Complications - prevention & control
Precision Medicine
T&H Historical Series
antiplatelet agents
thrombosis
arterial thrombosis
coagulation inhibitors
Acute Myocardial Infarction
ISSN:0340-6245, 2567-689X, 2567-689X
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Shrnutí:Abstract Platelet activation and aggregation have a pivotal role in arterial thrombosis and in the pathogenesis of both acute coronary syndromes (ACS) and in the thrombotic complications that occur in patients undergoing percutaneous coronary intervention (PCI). The past 30 years has seen the progress from early trials of clopidogrel and glycoprotein IIb/IIIa inhibitors to the application of more potent P2Y 12 inhibitors prasugrel and ticagrelor. Early enthusiasm for newer and more potent antiplatelet agents, which could reduce ischemic events, has led to the understanding of the importance of bleeding and a desire to individualize and optimize treatment. It has increasingly become apparent that the potency and duration of dual antiplatelet therapy (DAPT) has to reflect the balance between ischemic and bleeding risk. Recently, multiple strategies have been proposed to individualize DAPT intensity and duration to reduce the bleeding and ischemic risks. Strategies of de-escalation of DAPT intensity, as well as shorter (less than a year) or more prolonged (beyond a year) treatment have been proposed, as well as platelet function test and genotype guidance of P2Y 12 inhibitor therapy. Herein, we provide an overview of the progress in the field of antiplatelet therapy for ACS and PCI over the years, showing the current directions of travel. Ongoing studies focusing on personalized antiplatelet treatment will hopefully yield further insight into ways of optimizing outcomes for the individual.
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ISSN:0340-6245
2567-689X
2567-689X
DOI:10.1055/s-0040-1702920