Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3793_Библиотеки_им_академика_М_И_Перельмана

with other platelet inhibitors could provide added benefit. Additional agents that inhibit the platelet P2Y12 adenosine diphosphate (ADP) receptor have been shown to have added efficacy in reducing ischemic events among patients with acute MI and DAPT: using a combination of aspirin and a P2Y12 antagonist is currently recommended for secondary prevention for virtually all patients. The oral P2Y12 antagonists include the thienopyridines, ticlopidine, clopidogrel, and prasugrel, which are prodrugs whose active metabolites irreversibly bind to and inhibit the P2Y12 receptor and the direct acting, nonthienopyri­dine, reversible antagonist, ticagrelor (Table 12.1). Ticlopidine, the oldest member of this class, was shown to reduce the risk of stent thrombosis compared with prior treatments,39 but owing to a risk of serious neutropenia, thrombotic thrombocytopenic purpura (TTP) and aplastic anemia, it was replaced by clopidogrel for the reduction of atherothrombotic events following stent implantation.40 Ticlopidine continues to have a minor role for the uncommon patient allergic to or intolerant of clopidogrel, but the availability of newer P2Y12 antagonists has limited its current use. A parenteral short-acting reversible P2Y12 antagonist, cangrelor, is also available for early infusion to support PCI among patients who have not been pretreated with an oral P2Y12 antagonist (see Table 12.1) prior to intervention.