Antiplatelet Therapy Considerations in Ischemic Cardiogenic Shock: Implications of Metabolic Bioactivation.

Abstract:

:Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist remains a mainstay in the prevention of ischemic events following coronary stent placement. Significant controversy exists regarding the optimal management of high platelet reactivity despite antiplatelet therapy; however this finding has been consistently associated with poor clinical outcomes including greater risk of stent thrombosis and myocardial infarction. Variability in antiplatelet effects of clopidogrel and prasugrel has been linked to genetic polymorphisms and potential drug-drug interactions. Both of these factors have significant influence on the cytochrome P-450 enzyme system activity of the liver responsible for their biotransformation to the active form of both drugs. Very little has been publicized regarding differences in antiplatelet effects which may be associated with conditions in which the functional capacity of the liver may be temporarily compromised. Patients who present with cardiogenic shock due to acute coronary syndromes have evidence of multiorgan dysfunction including liver dysfunction that may affect the activity of these drugs. This review aims to explore existing evidence and propose additional considerations to the selection of antiplatelet therapy in patients with cardiogenic shock who receive catheter-based revascularization and stent placement.

authors

Weeks PA,Sieg A,Paruthi C,Rajapreyar I

doi

10.1177/1074248415571456

subject

Has Abstract

pub_date

2015-07-01 00:00:00

pages

370-7

issue

4

eissn

1074-2484

issn

1940-4034

pii

1074248415571456

journal_volume

20

pub_type

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