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Thromb Haemost 2023; 123(02): 150-158
DOI: 10.1055/s-0042-1753479
Theme Issue Article

Parenteral Antiplatelet Drugs in ST-Elevation Myocardial Infarction: Current Status and Future Directions

Sem A. O. F. Rikken 
1   Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
2   School for Cardiovascular Diseases, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
,
Robert F. Storey
3   Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
,
Felicita Andreotti
4   Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Peter Clemmensen
5   Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
6   Department of Medicine, Nykøbing F Hospital, Nykøbing Falster, Denmark
,
Jurriën M. ten Berg
1   Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
2   School for Cardiovascular Diseases, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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Abstract

Oral inhibitors of the platelet P2Y12 receptor are indispensable in the treatment of ST-elevation myocardial infarction (STEMI), improving outcomes and even reducing mortality in some studies. However, these drugs are limited by delayed absorption and suboptimal platelet inhibition at the time of primary percutaneous coronary intervention. Despite efforts to achieve faster and more sustained platelet inhibition, strategies such as prehospital administration, higher loading doses, and crushed formulations have not led to improved coronary reperfusion. Parenteral glycoprotein IIb/IIIa inhibitors act sooner and are more potent than oral P2Y12 inhibitors, but their use has been limited by the increased risk of major bleeding and thrombocytopenia. Hence, there is a clinical need to refine drugs that deliver rapid, effective, yet safe platelet inhibition in the setting of STEMI. Novel parenteral antiplatelet drugs, such as cangrelor, selatogrel, and zalunfiban, have been recently developed to achieve rapid, potent antiplatelet effects while preserving hemostasis. We provide a description of currently available parenteral antiplatelet agents and of those in clinical development for prehospital administration in STEMI patients.

Keywords

prehospital administration - antiplatelet drugs - ST-elevation myocardial infarction - cangrelor - selatogrel - zalunfiban


Publication History

Received: 31 March 2022

Accepted: 10 June 2022

Article published online:
08 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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