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From Detecting the Vulnerable Plaque to Managing the Vulnerable Patient Incidence, predictors, and outcomes associated with acute kidney injury in patients undergoing transcatheter aortic valve replacement: from the BRAVO-3 randomized trial Intravascular Ultrasound and Angioscopy Assessment of Coronary Plaque Components in Chronic Totally Occluded Lesions Coronary Access After TAVR Simple Electrocardiographic Measures Improve Sudden Arrhythmic Death Prediction in Coronary Disease Incidence and Outcomes of Surgical Bailout During TAVR : Insights From the STS/ACC TVT Registry Increased Risk of Valvular Heart Disease in Systemic Sclerosis: An Underrecognized Cardiac Complication Novel predictors of late lumen enlargement in distal reference segments after successful recanalization of coronary chronic total occlusion Impaired Retinal Microvascular Function Predicts Long-Term Adverse Events in Patients with Cardiovascular Disease Longitudinal Change in Galectin-3 and Incident Cardiovascular Outcomes
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Review Article2016 Jan;13(1):11-27.

JOURNAL：Nat Rev Cardiol. Article Link

Switching P2Y12-receptor inhibitors in patients with coronary artery disease

Rollini F, Franchi F, Angiolillo DJ. Keywords: switching antiplatelet treatment strategies with P2Y12-receptor inhibitors; drug switching; acute coronary syndrom;

ABSTRACT

Dual antiplatelet therapy--the combination of aspirin and a P2Y12-receptor inhibitor--is the cornerstone of treatment of patients with acute coronary syndromes (ACS) and of those undergoing percutaneous coronary intervention. Prasugrel and ticagrelor have more prompt, potent, and predictable antiplatelet effects than those of clopidogrel, and result in reduced ischaemic outcomes in patients with ACS, albeit at the expense of an increased risk of bleeding. However, clopidogrel is still very commonly used. Switching between oral P2Y12-inhibiting therapies occurs very frequently in clinical practice for a variety of reasons, which raises the question of which switching approaches are preferable. In 2015, cangrelor (an intravenous P2Y12-receptor inhibitor) was approved for clinical use, which adds to the conundrum of how to switch between intravenous and oral therapies. Differences in the pharmacology of P2Y12-receptor inhibitors, such as their binding sites (competitive or noncompetitive), half-life, and speed of onset and offset of action, are important factors that might lead to drug interactions when switching between agents. In this Review, we provide an overview of the literature on switching antiplatelet treatment strategies with P2Y12-receptor inhibitors, and discuss practical considerations for switching therapies in the acute and chronic phases of disease presentation.

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