Περίληψη:
Oral P2Y 12 receptor inhibitors represent a mainstay treatment in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. In the setting of ST-elevation myocardial infarction, when early platelet inhibition is highly desirable, the onset of action of oral P2Y 12 receptor inhibitors is, however, delayed, likely due to delayed drug absorption. Crushing the tablets, which are to be used for patient loading with an oral P2Y 12 receptor inhibitor, has been shown to provide earlier platelet inhibition than standard, integral tablets administration. Chewed ticagrelor tablets may also result in a similar effect. Such findings should be interpreted with caution, mainly due to the small number of patients enrolled and the nature (pharmacodynamic/pharmacokinetic) of the respective studies. Furthermore, in patients with out-of-hospital cardiac arrest, who remain comatose, crushing tablets is commonly applied in clinical practice for platelet P2Y 12 receptor inhibition. In this review, we focus on current evidence regarding the role of crushed P2Y 12 receptor inhibitor pills, analyzing clinical scenarios where most of the promise exists along with future expectations from this type of formulation. Large randomized studies are needed to draw firm conclusions regarding the clinical benefit of 'crushing' over the usual 'not-crushing' practice. © 2019 Georg Thieme Verlag KG Stuttgart - New York.
Συγγραφείς:
Alexopoulos, D.
Dragasis, S.
Kafkas, N.
Λέξεις-κλειδιά:
cangrelor; clopidogrel; morphine; prasugrel; purinergic P2Y12 receptor; purinergic receptor blocking agent; ticagrelor; vasodilator stimulated phosphoprotein; purinergic P2Y receptor antagonist; ticagrelor, acute coronary syndrome; Article; bioequivalence; blood clot lysis; clinical outcome; drug absorption; drug bioavailability; drug half life; gastrointestinal absorption; human; out of hospital cardiac arrest; percutaneous coronary intervention; pharmacodynamic parameters; platelet reactivity; priority journal; receptor blocking; salivation; ST segment elevation myocardial infarction; acute coronary syndrome; drug effect; drug formulation; percutaneous coronary intervention; physiology; procedures; tablet; thrombocyte, Acute Coronary Syndrome; Blood Platelets; Drug Compounding; Humans; Percutaneous Coronary Intervention; Purinergic P2Y Receptor Antagonists; Tablets; Ticagrelor
