High and low on-treatment platelet reactivity to P2Y12 inhibitors in a contemporary cohort of acute coronary syndrome patients undergoing percutaneous coronary intervention

Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study

“…A reduced PRI is indicative of greater inhibition of the P2Y12 signaling pathway. The cutoff value used to define HPR was ≥50% …”

“…The variability in the pharmacodynamic response to clopidogrel, the most commonly used P2Y12 antagonist in China, may exert an adverse impact on clinical outcomes. High platelet reactivity (HPR) to antiplatelet therapy is associated with a higher risk of ischemic events, while low platelet reactivity increases bleeding risk . Novel antiplatelet agents, such as prasugrel or ticagrelor, have been recommended for treating patients with acute coronary syndrome (ACS) .…”

“…High platelet reactivity (HPR) to antiplatelet therapy is associated with a higher risk of ischemic events, while low platelet reactivity increases bleeding risk. [4][5][6] Novel antiplatelet agents, such as prasugrel or ticagrelor, have been recommended for treating patients with acute coronary syndrome (ACS). 4 However, due to limited availability, higher cost, and contraindications, the clinical introduction of these agents is still low in some regions.…”

Recommendations on antithrombotic treatment during the COVID-19 pandemic. Position statement of the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology

“…Once antivirals are stopped, thus eliminating the risk of drug interaction, the prescribed P2Y 12 inhibitor should be changed to the P2Y 12 inhibitor that would have been selected under normal circumstances. 31 If this change is performed in the acute phase of an event, loading doses of the drug must be administered. 28 Acute coronary syndromes with large thrombotic loads can occur in the context of an infection with high inflammatory and prothrombotic potential.…”

Recomendaciones sobre el tratamiento antitrombótico durante la pandemia COVID-19. Posicionamiento del Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología

“…Si se considera imprescindible emplear alguno de los tratamientos antivirales que condicionan una interacción con clopidogrel o ticagrelor, entonces sí sería razonable prescribir prasugrel durante el tiempo que se administren dichos fármacos, aunque siempre hay que tener presentes las contraindicaciones (ictus previo) y las precauciones (edad > 75 años, peso < 60 kg, antecedente de hemorragia). Después, una vez se suspendan los mencionados antivirales (depende de los protocolos locales, pero se suele pautar pocos días y no más de 1-2 semanas) y el riesgo de interacción farmacológica desaparezca, lo razonable sería proceder al cambio del antagonista del P2Y12, caso de ser preciso, por el que se hubiera seleccionado en circunstancias normales 31 . Cabe recordar que dicho cambio, si es en la fase aguda de un evento, se debe realizar administrando dosis de carga del fármaco 28 .…”