International Expert Consensus on Switching Platelet P2Y12 Receptor-Inhibiting Therapies
International Expert Consensus on Switching Platelet P2Y12 Receptor-Inhibiting Therapies
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DOI：
10.1161/circulationaha.117.031164
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发表时间：
2017-11-14
期刊：
影响因子：
37.8
通讯作者：
Price, Matthew J.
中科院分区：
文献类型：
--
作者：
Angiolillo, Dominick J.;Rollini, Fabiana;Price, Matthew J.
使用阿司匹林和一种P2Y(12)抑制剂的双重抗血小板疗法是预防急性冠状动脉综合征患者和接受经皮冠状动脉介入治疗的患者动脉粥样硬化血栓形成事件的首选治疗方法。不同的口服P2Y(12)抑制剂(氯吡格雷、普拉格雷、替卡格雷)的可获得性使医生能够考虑根据特定的临床情况在不同的治疗方案之间进行切换。最近静脉注射的P2Y(12)抑制剂(Cangrelor)的引入进一步增加了可能发生切换治疗的多种模式和环境。在临床实践中，切换P2Y(12)抑制剂并不少见，切换可能与多种因素有关。然而，对在这些代理之间切换的安全性的担忧已经出现。实践指南还没有完全详细说明如何切换疗法，这使得临床医生在需要时何时以及如何切换疗法方面的指导有限。这促使来自北美和欧洲的主要领导人制定了这份专家共识文件，他们在抗血小板治疗领域拥有基础、翻译和临床科学方面的专业知识。这一专家共识概述了P2Y(12)抑制剂的药理学，切换的不同模式和定义，以及可用文献和关于在P2Y(12)抑制剂之间切换的建议。
Dual antiplatelet therapy with aspirin and a P2Y(12) inhibitor is the treatment of choice for the prevention of atherothrombotic events in patients with acute coronary syndromes and for those undergoing percutaneous coronary interventions. The availability of different oral P2Y(12) inhibitors (clopidogrel, prasugrel, ticagrelor) has enabled physicians to contemplate switching among therapies because of specific clinical scenarios. The recent introduction of an intravenous P2Y(12) inhibitor (cangrelor) further adds to the multitude of modalities and settings in which switching therapies may occur. In clinical practice, it is not uncommon to switch P2Y(12) inhibitor, and switching may be attributed to a variety of factors. However, concerns about the safety of switching between these agents have emerged. Practice guidelines have not fully elaborated on how to switch therapies, leaving clinicians with limited guidance on when and how to switch therapies when needed. This prompted the development of this expert consensus document by key leaders from North America and Europe with expertise in basic, translational, and clinical sciences in the field of antiplatelet therapy. This expert consensus provides an overview of the pharmacology of P2Y(12) inhibitors, different modalities and definitions of switching, and available literature and recommendations for switching between P2Y(12) inhibitors.