P2Y12-inhibitors in NSTEMI - old and new guidelines

Focus on

Needs assessment:

The new ESC Clinical Practice Guidelines on NSTEMI recommend prasugrel over ticagrelor in ACS patients referred for percutaneous coronary intervention (PCI). At the same time, these guidelines recommend using prasugrel only after the coronary anatomy is known and avoiding pre-cath lab use of P2Y12 inhibitors. This changes clinical routine essentially:

1. In many systems of ACS care, high-risk ACS patients cannot be treated by PCI within 24 hours of diagnosis and are, therefore, frequently pre-treated with ticagrelor or clopidogrel.
2. Patients with ACS but without indication for PCI frequently receive ticagrelor as a conservative strategy.
3. In ACS patients with high or very high bleeding risk and in patients without increased bleeding risk, clopidogrel and ticagrelor, respectively, have been tested for short DAPT (one to three months), followed by P2Y12 inhibitor monotherapy with significantly reduced bleeding hazards, but with similar ischaemic outcome. No data are currently available for the use of prasugrel in this strategy.

Learning objectives

After watching this webinar, participants will be able to:

• recognise the correct use of P2Y12 inhibitors (ticagrelor and prasugrel) in patients presenting with non-ST-elevation ACS;
• implement into practice the ‘2020 ESC Guidelines on Non-ST-Elevation ACS’; and
• manage new indications for ticagrelor in ACS patients, namely as monotherapy after short-duration DAPT.