Optimal intravenous antiplatelet therapy in patients with ST-elevation myocardial infarction: is the picture becoming clearer?

Excerpt

In patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), immediate and effective platelet inhibition is crucial to prevent thrombotic complications and reduce ischemic events. The current standard of care is to administer oral loading doses of potent third-generation P2Y₁₂ receptor inhibitors (ticagrelor or prasugrel) upon diagnosis. However, oral P2Y₁₂ receptor inhibitor treatment in STEMI is frequently limited by the delayed onset of action, requiring up to 4–6 h to achieve full antiplatelet effects, and exposing patients to unnecessary early risk of thrombotic complications during and shortly after PCI [1]. This is also aggravated by the impaired gastrointestinal absorption driven by a combination of hemodynamic instability and the effect of frequently coadministered opioid sedatives [2]. To bridge the gap in platelet inhibition, two classes of intravenous antiplatelet agents have been used in the early stage of STEMI management, namely intravenous P2Y₁₂ receptor inhibitors and glycoprotein IIb/IIIa receptor inhibitors (GPI). Nonetheless, the beneficial effect of intravenous agents on thrombosis has been partially counterbalanced by an increased risk of bleeding. …