How to manage prasugrel and ticagrelor in daily practice

作者：Bonhomme Fanny^*; Fontana Pierre; Reny Jean Luc

来源：European Journal of Internal Medicine, 2014, 25(3): 213-220.

DOI：10.1016/j.ejim.2014.01.016

• Prasugrel
• Ticagrelor
• Pharmacology
• Peri-operative period
• Blood loss
• Surgical

Prasugrel and ticagrelor are next-generation antiplatelet agents that provide a rapider and more potent inhibition of platelet P2Y12 receptor than clopidogrel. In combination with aspirin, these new P2Y12 inhibitors are now the first line treatments for patients with acute coronary syndrome. However, these potent antiplatelet agents introduce a new paradigm in the daily management of antithrombotic drugs, particularly when an invasive procedure is planned. The pharmacology of these antiplatelet agents, and the results of the main clinical trials, are reviewed with a special focus on good prescription practices (indications, contra-indications, drug interactions), and on peri-operative management. Strategies are proposed for safely reducing the bleeding risk in elderly patients, in patients requiring concomitant oral anticoagulant therapy, or in patients with an increased haemorrhagic risk.

• 出版日期2014-3