Defining a Role for Prasugrel in Patients With Stable Coronary Artery Disease Undergoing Ad Hoc Percutaneous Coronary Intervention.

I n patients undergoing percutaneous coronary intervention (PCI), pre-treatment with a P2Y12 receptor inhibitor has been for years advocated as a strategy to protect from periprocedural thrombotic events (1). However, most recently, the need for pre-treatment before diagnostic angiography has been largely debated, particularly in patients with stable coronary artery disease (CAD) (1,2). Accordingly, although practice guidelines have traditionally advocated the importance of early initiation of P2Y12inhibiting therapies in patients undergoing PCI, most recent guidelines provide less emphasis on timing of initiation of treatment (1). Nevertheless, effective levels of P2Y12 receptor blockade reduce ischemic events in the vulnerable peri-PCI period (3). However, systematic upstream administration of a P2Y12 receptor inhibitor in all patients going to the catheterization laboratory inevitably leads to unnecessary treatment of those who do not require PCI; moreover, this can also increase the risk of hemorrhagic complications and prolong hospitalization in patients requiring surgical revascularization (1).