Menozzi Alberto, Caretta Giorgio
Division of Cardiology, Sant'Andrea Hospital, ASL 5 Liguria, La Spezia, Italy.
Eur Heart J Suppl. 2020 Nov 18;22(Suppl L):L97-L100. doi: 10.1093/eurheartj/suaa144. eCollection 2020 Nov.
Antiplatelet agents represent one of the cornerstones of drug therapy for acute coronary syndromes (ACS). In the last decade, the arrival of prasugrel and ticagrelor, faster and more powerful oral platelet receptor P2Y12 inhibitors compared to clopidogrel, significantly improved platelet inhibition in patients with ACS. However, the reduction of thrombotic risk came at the cost of increased bleeding risk. Despite having similar indications, prasugrel and ticagrelor have different characteristics and methods of use, essentially due to a different design of the trials in which they have been studied. The optimal use of these antiplatelets in clinical practice should therefore be tailored in individual patients. In the acute phase of ACS with high thrombotic burden, all oral P2Y12 inhibitors have limitations, mainly due to the delay of onset of action related to oral administration. In this scenario, parenteral antiplatelet agents (glycoprotein inhibitors IIb/IIIa and cangrelor) may play a key role in case of percutaneous coronary interventions of high thrombotic coronary lesions and in the prevention of early thrombotic complications. Cangrelor, an intravenous inhibitor of the P2Y2 receptor, has peculiar pharmacokinetic and pharmacodynamic characteristics that make it particularly suitable to be used as an antiplatelet during coronary angioplasty as it achieves a rapid and powerful antiplatelet effect in patients not pretreated with oral medications, and has a favourable safety profile in relation to the bleeding risk.
抗血小板药物是急性冠状动脉综合征（ACS）药物治疗的基石之一。在过去十年中，普拉格雷和替格瑞洛的出现，与氯吡格雷相比，它们是更快、更强效的口服血小板受体P2Y12抑制剂，显著改善了ACS患者的血小板抑制作用。然而，血栓形成风险的降低是以出血风险增加为代价的。尽管普拉格雷和替格瑞洛有相似的适应证，但它们具有不同的特性和使用方法，这主要是由于研究它们的试验设计不同。因此，在临床实践中这些抗血小板药物的最佳使用应根据个体患者进行调整。在血栓负荷高的ACS急性期，所有口服P2Y12抑制剂都有局限性，主要是由于口服给药相关的起效延迟。在这种情况下，对于高血栓负荷冠状动脉病变的经皮冠状动脉介入治疗以及预防早期血栓形成并发症，肠外抗血小板药物（糖蛋白抑制剂IIb/IIIa和坎格雷洛）可能发挥关键作用。坎格雷洛是一种P2Y2受体静脉抑制剂，具有独特的药代动力学和药效学特性，使其特别适合在冠状动脉血管成形术期间用作抗血小板药物，因为它在未接受口服药物预处理的患者中能实现快速且强效的抗血小板作用，并且在出血风险方面具有良好的安全性。
