Evaluating current and emerging antithrombotic therapy currently available for the treatment of acute coronary syndrome in geriatric populations

Medical Research Journal

Jaguszewski

Ostrowska

et al. 2020

Self Cite

Discordant interpretations of the results of clinical trials often drive scientific disputes. Our position concerning the protocol and performance of the ISAR-REACT 5 trial have been termed as false and groundless in the recently published article. We deeply disagree with this judgement and still maintain all our opinions expressed in the previous publications, without any exceptions. As demonstrated in multiple studies, prasugrel has excellent effectiveness and predictability. In our previous publications, it was not the drug itself that we put under criticism, but rather the quality of the trial assessing the drug. As a consequence of this critical approach, we stated that taking into account the serious limitations of the ISAR-REACT 5 trial, its results should be taken with cautiousness. To summarize, we remain open to further creative scientific dispute enriching both readers and authors.

Section: Critical Analysis and Disputementioning

confidence: 77%

Creative scientific dispute — different points of view on the protocol and execution of the ISAR-REACT 5 trial

Medical Research Journal

Jaguszewski

Ostrowska

et al. 2020

Self Cite

“…Tolerability of DAPT during the recommended 12-month therapy period and reduction of the risk of ischemic events outweighing the elevated bleeding risk is a premise for prolonged therapy with a P2Y12 re-ceptor inhibitor and ASA [23][24][25]. According to the citations in the ESC guidelines [10,11], indications to use clopidogrel, prasugrel, or ticagrelor in combination with ASA in patients with CCS after ACS are based on the data coming from the DAPT [14,15,26], TL-PAS [16], and PEGASUS-TIMI 54 trials [17][18][19][20][21].…”

Section: Dual Antiplatelet Therapy With Asa and A P2y12 Receptor Inhimentioning

confidence: 99%

Prolonged antithrombotic therapy in patients after acute coronary syndrome: A critical appraisal of current European Society of Cardiology guidelines

Medical Research Journal

Adamski

Niezgoda

et al. 2020

Self Cite

The increased risk of non-cardiovascular death in patients receiving clopidogrel or prasugrel in comparison with the placebo group in the Dual Antiplatelet Therapy (DAPT) trial in contrast to the decreased risk of cardiovascular death and all-cause death seen in patients treated with low-dose ticagrelor in the EU label population of the PEGASUS-TIMI 54 trial, resulted in inclusion in the 2020 ESC NSTE-ACS guidelines the recommendation for use of clopidogrel or prasugrel only if the patient is not eligible for treatment with ticagrelor.

“…Contemporary armamentarium of the P2Y 12 receptor inhibitors includes two thienopyridines: clopidogrel and prasugrel, and two non-thienopyridine drugs: ticagrelor and cangrelor (19). Thienopyridines are oral pro-drugs demanding hepatic activation via cytochrome P450, their metabolites irreversibly bind to the P2Y 12 receptors for 7–10 days, which may impact the time to surgery after cessation (20).…”

Section: Antiplatelet Agentsmentioning

confidence: 99%

Stratified Approaches to Antiplatelet Therapies Based on Platelet Reactivity Testing

Ostrowska

Front. Cardiovasc. Med.

Adamski

et al. 2019

Self Cite

Antiplatelet therapy with P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor, cangrelor) is a cornerstone of medical therapy after percutaneous coronary interventions. Significant prevalence of high on-treatment platelet reactivity (HTPR) on clopidogrel treatment led to introduction of more potent P2Y12 inhibitors: prasugrel (a third generation thienopyridine), ticagrelor, and cangrelor (cyclopentyl-triazolo-pyrimidines). Nevertheless, more potent platelet inhibition and resulting low on-treatment platelet reactivity (LTPR) has led to increased risk of major bleeding events. These limitations resulted in a need for an individualized antiplatelet therapy approach. This review discusses the current role and future perspectives of diagnostic tools such as platelet function testing to optimize antiplatelet therapy with a focus on deescalating therapies to reduce bleeding risks.