Optimal timing of initiation of oral P2Y12-receptor antagonist therapy in patients with non-ST elevation acute coronary syndromes. Lessons learnt from the ACCOAST-trial

Eur Heart J Acute Cardiovasc Care. 2016 Jun;5(3):282-8. doi: 10.1177/2048872615584076. Epub 2015 Apr 28.

Abstract

The optimal time-point of the initiation of P2Y12 antagonist therapy in patients with non-ST elevation acute coronary syndromes (NTSE-ACS) is still a matter of debate. European guidelines recommend P2Y12 as soon as possible after first medical contact. However, the only trial which compared the two strategies did not demonstrate any benefit of pre-treatment with prasugrel before angiography compared to starting therapy after angiography and just prior to percutaneous coronary intervention (PCI). This paper summarizes the results of pharmacodynamic and previous studies, and gives recommendations for the initiation of P2Y12 antagonist therapy in NSTE-ACS in different clinical situations.

Keywords: Non ST elevation myocardial infarction; P2Y12 antagonists; Pretreatment.

MeSH terms

  • Acute Coronary Syndrome / drug therapy*
  • Administration, Oral
  • Clinical Trials as Topic
  • Coronary Angiography
  • Female
  • Humans
  • Male
  • Percutaneous Coronary Intervention
  • Practice Guidelines as Topic
  • Prasugrel Hydrochloride / administration & dosage*
  • Prasugrel Hydrochloride / therapeutic use
  • Purinergic P2Y Receptor Antagonists / administration & dosage*
  • Purinergic P2Y Receptor Antagonists / therapeutic use
  • Treatment Outcome

Substances

  • Purinergic P2Y Receptor Antagonists
  • Prasugrel Hydrochloride