Since its first approval in 1997, clopidogrel has revolutionized interventional cardiology and transformed therapy for non‑ST‑segment elevation myocardial infarction (NSTEMI), STEMI, and percutaneous coronary intervention‑treated patients. It enjoyed a remarkable 15‑year "homerun" in the world market without any major competition. With the introduction of more potent P2Y12 receptor blockers, th...

It is known that hepatic metabolism limits the antiaggregatory activity of clopidogrel and, as a consequence, its clinical benefits. In this study, we investigated whether other factors exist that could account for clopidogrel’s suboptimal antithrombotic activity. Using an in vivo murine FeCl3 thrombosis model coupled with intravital microscopy, we found that at equivalent, maximal levels of in...

We read with interest the editorial by Drs. Freedman and Iafrati recently published in Revista Española de Cardiologı́a. The editorial mentions that prasugrel is an inhibitor of the P2Y12 receptor, that it is not metabolized in the liver, and that it does not appear to be affected by the variability of isozyme P450. We believe that it might be a good idea here to indicate the pharmacokinetic cha...

In patients pretreated with P2Y12 receptor inhibitors who need to undergo non-emergent cardiac or major non-cardiac surgery, current guidelines of the European Society of Cardiology recommend postponing surgery for at least five days after last intake of clopidogrel or ticagrelor, and for seven days after last intake of prasugrel, unless there is high risk of ischemic events. However, a fixed f...

Decades after the introduction of oral anti-coagulants namely the vitamin K antagonist (VKA) Warfarin and antiplatelet agents such as Aspirin and Plavix, new classes of direct, small molecule, novel oral anti-coagulant medications and antiplatelet P2Y12 receptor inhibitors have recently become available. For the novel oral anticoagulants (NOAC), these agents can be separated by direct thrombin ...

Ticagrelor is a reversibly binding, noncompetitive, direct-acting, orally administered P2Y12-receptor antagonist and is a credible alternative to clopidogrel in the treatment of patients with acute coronary syndrome. Ticagrelor therapy has been associated with rapid onset and faster offset of actions and greater and consistent platelet inhibition. In the Study of Platelet Inhibition and Patient...

OBJECTIVES The aim of this study was to assess the impact of ticagrelor dosing regimens on pharmacodynamic (PD) profiles in patients on maintenance ticagrelor therapy. BACKGROUND Many patients on maintenance P2Y12-inhibiting therapies may require coronary revascularization procedures, raising a common clinical question with regard to the dosing regimen of the P2Y12-inhibiting agent to be used...

THE CLINICAL EFFICACY OF ORAL P2Y12 ANTAGOnists in reducing recurrent cardiovascular events in patients with acute coronary syndromes (ACS) treated with percutaneous coronary intervention (PCI) or with either a conservative or early invasive strategy is well established. However, the effect of clopidogrel on P2Y12-mediated platelet reactivity varies widely among individuals. Platelet function t...