The considerable progress in P2Y12-platelet blockers has important perioperative implications due to a family of novel
agents beyond clopidogrel. Although prasugrel is more potent than clopidogrel due
to more efficient hepatic metabolism, it is limited clinically by its irreversibility
and bleeding risks. Ticagrelor, as the first approved direct and reversible oral P2Y12 blocker, still is limited clinically by its novel side-effect profile. Intravenous
reversible P2Y12 blockade is possible now with both cangrelor and elinogrel, although both agents
are still in clinical development. Furthermore, elinogrel offers the possibility of
both oral and parenteral P2Y12 blockade with a single agent. Future trials likely will continue to evaluate and
compare the safety and efficacy of these agents in multiple clinical settings, including
the perioperative period.
Key words
- platelets
- P2Y12 receptor
- adenosine diphosphate
- ticlopidine
- clopidogrel
- thienopyridines
- prasugrel
- ticagrelor
- cangrelor
- elinogrel
- guidelines
- perioperative period
- thrombosis
- bleeding
- percutaneous coronary intervention
- cardiac surgery
- noncardiac surgery
- coronary stent
- clopidogrel resistance
- hepatic metabolism
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Footnotes
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