Ticagrelor in stable coronary disease

Interventional cardiology luxuriously bathes in a pool of oral P2Y12 antiplatelet medications: ticlopidine, clopidogrel, prasugrel and ticagrelor. In the coming years, all of these agents will be available generically at modest cost to healthcare systems and patients. Once price no longer distinguishes among them, two factors will drive clinical selection. First, logistical practicalities differ such as side effects (hence the near abandonment of ticlopidine), drug interactions (for example, when transitioning off intravenous cangrelor) and administration (two times per day maintenance dosing of ticagrelor instead of once daily for clopidogrel and prasugrel). Second, clinical outcomes favour prasugrel and ticagrelor over clopidogrel but only for acute myocardial infarction. For stable patients, clinical advantages for prasugrel and ticagrelor have proven more elusive. However, the current PROMICRO-3 study offers new data regarding the impact of modern P2Y12 agents on surrogate endpoints of myocardial blood flow and injury.1 In brief, 50 stable...
Source: Heart - Category: Cardiology Authors: Tags: Editorials Source Type: research