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International Expert Consensus on Switching Platelet P2Y12 Receptor-Inhibiting Therapies.

  • Angiolillo, Dominick J1
  • Rollini, Fabiana2
  • Storey, Robert F3
  • Bhatt, Deepak L4
  • James, Stefan5
  • Schneider, David J6
  • Sibbing, Dirk7, 8
  • So, Derek Y F9
  • Trenk, Dietmar10
  • Alexopoulos, Dimitrios11
  • Gurbel, Paul A12
  • Hochholzer, Willibald10
  • De Luca, Leonardo13, 14, 15
  • Bonello, Laurent16
  • Aradi, Daniel17
  • Cuisset, Thomas18
  • Tantry, Udaya S12
  • Wang, Tracy Y19
  • Valgimigli, Marco20
  • Waksman, Ron21
  • And 4 more
  • 1 Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A., F.R., F.F.). [email protected]
  • 2 Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A., F.R., F.F.).
  • 3 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom (R.F.S.). , (United Kingdom)
  • 4 Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
  • 5 Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Sweden (S.J.). , (Sweden)
  • 6 Department of Medicine, Cardiology Unit, Cardiovascular Research Institute, University of Vermont, Burlington (D.J.S.).
  • 7 Department of Cardiology, Ludwig-Maximilians-Universität München, Germany (D.S.). , (Germany)
  • 8 DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (D.S.). , (Germany)
  • 9 Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada (D.Y.S.F.). , (Canada)
  • 10 Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany (D.T., W.H.). , (Germany)
  • 11 Second Department of Cardiology, National and Capodistrian University of Athens, Attikon University Hospital, Greece (D. Alexopoulos). , (Greece)
  • 12 Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, VA (P.A.G., U.S.T.).
  • 13 Division of Cardiology, Laboratory of Interventional Cardiology, San Giovanni Evangelista Hospital, Tivoli-Rome, Italy (L.D.L.). , (Italy)
  • 14 Mediterranean Academic Association for Research and Studies in Cardiology, Marseille, France (L.D.L.). , (France)
  • 15 Aix-Marseille University, INSERM UMRS 1076, Marseille, France (L.D.L.). , (France)
  • 16 Assistance Publique-Hôpitaux de Marseille, Department of Cardiology, Hôpital Nord, Marseille, France (L.B.). , (France)
  • 17 Heart Center Balatonfüred and Semmelweis University Budapest, Hungary (D. Aradi). , (Hungary)
  • 18 Department of Cardiology, CHU Timone, and Aix-Marseille Université, Faculté de Médecine, Marseille, France (T.C.). , (France)
  • 19 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (T.Y.W.).
  • 20 Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (M.V.). , (Switzerland)
  • 21 Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W.).
  • 22 Icahn School of Medicine at Mount Sinai, New York City, NY (R.M.).
  • 23 Sorbonne Université Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, France (G.M.). , (France)
  • 24 Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA (M.J.P.).
Published Article
Ovid Technologies Wolters Kluwer -American Heart Association
Publication Date
Nov 14, 2017
DOI: 10.1161/CIRCULATIONAHA.117.031164
PMID: 29084738


Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is the treatment of choice for the prevention of atherothrombotic events in patients with acute coronary syndromes and for those undergoing percutaneous coronary interventions. The availability of different oral P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) has enabled physicians to contemplate switching among therapies because of specific clinical scenarios. The recent introduction of an intravenous P2Y12 inhibitor (cangrelor) further adds to the multitude of modalities and settings in which switching therapies may occur. In clinical practice, it is not uncommon to switch P2Y12 inhibitor, and switching may be attributed to a variety of factors. However, concerns about the safety of switching between these agents have emerged. Practice guidelines have not fully elaborated on how to switch therapies, leaving clinicians with limited guidance on when and how to switch therapies when needed. This prompted the development of this expert consensus document by key leaders from North America and Europe with expertise in basic, translational, and clinical sciences in the field of antiplatelet therapy. This expert consensus provides an overview of the pharmacology of P2Y12 inhibitors, different modalities and definitions of switching, and available literature and recommendations for switching between P2Y12 inhibitors.

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