In the field ofpurinergic signaling, theP2Y12protein on the periphery is found mainly but not exclusively on the surface ofbloodplatelets, and is an important regulator in bloodclotting.[9] In the central nervous system, this receptor has been found expressed exclusively onmicroglia, where it is necessary for physiological and pathological microglial actions, such as monitoring neuronal functions and microglial neuroprotection.[10]
The combination of a P2Y12 inhibitor andaspirin, called dual antiplatelet treatment, remains the first-line treatment foracute coronary syndrome. A 2019 randomized trial suggested that prasugrel is superior to ticagrelor.[11]
In patients undergoing primarypercutaneous coronary intervention (PCI) for an ST-segment elevation myocardial infarction (STEMI), US,[12] European,[13] and Canadian[14] guidelines recommend that a P2Y12 inhibitor should be administered as soon as possible, although it is unclear whether administration of these medications before the patient arrives at the hospital confers additional benefits compared with in-hospital administration.[14]
On the other hand, P2Y12 inhibitors do not change the risk of death when given as a pretreatment prior to routine PCI in people who have had a non-ST-elevation myocardial infarction (NSTEMI). Though, a P2Y12 inhibitor in addition to aspirin should be administered for up to 12 months to most patients with non-ST-elevation acute coronary syndrome. They do however increase the risk of bleeding and decrease the risk of further cardiovascular problems. Thus their routine use in this context is of questionable value.[15]
Anetwork meta-analysis of 37 studies involving 88,402 STEMI patients and 5,077major adverse cardiac events (MACE) patients found that use of prasugrel was associated with lower mortality and MACE than other drugs in this class (clopidogrel and ticagrelor).[16]
