Key result
Tailored pharmacotherapy in STEMI patients undergoing PCI favors ticagrelor and prasugrel as first-line P2Y12 inhibitors.
Prasugrel and ticagrelor are recommended as first-line P2Y12 inhibitors for STEMI patients undergoing primary PCI, though balancing thrombotic and bleeding risks remains challenging.
Supports risk-tailored P2Y12 selection in STEMI PCI; leaves open need for updated RCTs on bleeding-ischemic balance.
Antithrombotic therapy is an essential component in the optimisation of clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. There are currently several intravenous anticoagulant drugs available for primary percutaneous coronary intervention. Dual antiplatelet therapy comprising aspirin and P2Y12 inhibitor represents the cornerstone treatment for STEMI. However, these effective treatment strategies may be associated with bleeding complications. Compared with clopidogrel, prasugrel and ticagrelor are more potent and predictable, which translates into better clinical outcomes. Therefore, these agents are the first-line treatment in primary percutaneous coronary intervention. However, patients can still experience adverse ischaemic events, which might be in part attributed to alternative pathways triggering thrombosis. In this review, we provide a critical and updated review of currently available antithrombotic therapies used in patients with STEMI undergoing primary PCI. Finding a balance that minimises both thrombotic and bleeding risk is difficult, but crucial. Further randomised trials for this optimal balance are needed.
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Hermanides et al. (2018) conducted a review in ST-elevation myocardial infarction (STEMI). Antithrombotic and antiplatelet therapy was evaluated. Adjunctive pharmacotherapy in STEMI patients undergoing primary PCI should be tailored to the individual based on ischemic and bleeding risks, with ticagrelor and prasugrel as first-line P2Y12 inhibitors.
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