Switching between P2Y12 antagonists - From bench to bedside

Abstract

Platelet P2Y₁₂ receptors play a key role in platelet activation and thrombus formation. Accordingly, P2Y₁₂ receptor antagonists are the cornerstone of secondary prevention of atherothrombotic events in patients undergoing percutaneous coronary intervention (PCI). The availability of different oral P2Y₁₂ antagonists (clopidogrel, prasugrel, ticagrelor) along with the introduction of the first intravenous P2Y₁₂ antagonist cangrelor offer an opportunity to individualize antiplatelet therapy according to the changing clinical setting. The recent International Expert Consensus provided the first recommendations on switching between the P2Y₁₂ antagonists. While the consensus greatly helps to guide switching between P2Y₁₂ antagonists, a number of controversial clinical scenarios remain where the evidence regarding the optimal switch strategy is scarce. In such clinical scenarios, understanding of the (i) pharmacological properties of P2Y₁₂ antagonists, (ii) recent evidence from pharmacodynamics studies, clinical trials and registries, and (iii) factors affecting the efficacy and safety of the P2Y₁₂ antagonists, all summarized below, are crucial to choose the optimal switch strategy.

Keywords: Acute coronary syndrome; Antiplatelet drugs; Myocardial infarction; P2Y12 receptor; Switch.