The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients
Worldwide, ischemic heart disease is the most common cause of death and its frequency is increasing. ST-segment elevation myocardial infarction or STEMIis as form of ischemic heart disease with the highest mortality rate. Based on ESC (European Society of Cardiology) guideline 2017 for STEMI mana...
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| Format: | Article |
| Language: | English |
| Published: |
Indonesian Heart Association
2019-09-01
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| Series: | Majalah Kardiologi Indonesia |
| Subjects: | |
| Online Access: | http://ijconline.id/index.php/ijc/article/view/915 |
| _version_ | 1811275927176347648 |
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| author | Daniel Tobing Dafsah Juzar Achmad Fauzi Yahya Antonia Anna Lukito Doni Firman Sodiqur Rifqi Abdul Hakim Alkatiri Rurus Suryawan |
| author_facet | Daniel Tobing Dafsah Juzar Achmad Fauzi Yahya Antonia Anna Lukito Doni Firman Sodiqur Rifqi Abdul Hakim Alkatiri Rurus Suryawan |
| author_sort | Daniel Tobing |
| collection | DOAJ |
| description | Worldwide, ischemic heart disease is the most common cause of death and its frequency is increasing. ST-segment elevation myocardial infarction or STEMIis as form of ischemic heart disease with the highest mortality rate.
Based on ESC (European Society of Cardiology) guideline 2017 for STEMI management, reperfusion therapywhich is primary PCI strategy is recommended over fibrinolysis within induced timeframes, but if timely primary PCI cannot be performed after STEMI diagnosis, fibrinolytic therapy is recommended within 12 hours of symptom onset in patients without contraindications. In fibrinolytic therapy, oral aspirin should be given, and Clopidogrel is indicated as an addition to aspirin. Although Clopidogrel is a recommended P2Y12receptor inhibitorin fibrinolytic therapy,PERKI guideline 2018 in ACS management also mention thatswitching to Ticagrelor can be considered in patients whowillundergo PCI treatmentafter fibrinolytic.
In PLATO study, patients who have acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke. However, patients who received fibrinolytic therapy within 24 hours before randomization were excluded. WhileinSET-FAST study, Ticagrelor provides more prompt and potent platelet inhibition compared with Clopidogrel in patients undergoing PCI within 24 hours of receiving fibrinolysis for STEMI. TREAT study was conducted to evaluate the safety of ticagrelor in STEMI patients receiving fibrinolytic therapy within 24 hours.TREAT study concluded, at 30 days observation, in patients younger than 75 years with STEMI, delayed administration of Ticagrelor after fibrinolytic therapy was noninferior to Clopidogrel for TIMI major bleeding.
Based on the result from PLATO study and preliminary TREAT study result on 30 days, the use of Ticagrelor within 24 hours after fibrinolytic therapy can be considered with comparable safety profile to Clopidogrel.
Keywords: STEMI, fibrinolysis, ticagrelor |
| first_indexed | 2024-04-12T23:47:31Z |
| format | Article |
| id | doaj.art-dd119dd747684ba4855a985f50a62df1 |
| institution | Directory Open Access Journal |
| issn | 0126-3773 2620-4762 |
| language | English |
| last_indexed | 2024-04-12T23:47:31Z |
| publishDate | 2019-09-01 |
| publisher | Indonesian Heart Association |
| record_format | Article |
| series | Majalah Kardiologi Indonesia |
| spelling | doaj.art-dd119dd747684ba4855a985f50a62df12022-12-22T03:11:50ZengIndonesian Heart AssociationMajalah Kardiologi Indonesia0126-37732620-47622019-09-0140410.30701/ijc.v40i4.915The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian PatientsDaniel TobingDafsah Juzar0Achmad Fauzi Yahya1Antonia Anna Lukito2Doni Firman3Sodiqur Rifqi4Abdul Hakim Alkatiri5Rurus Suryawan6Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta IndonesiaDepartment of Cardiology and Vascular Medicine,Universitas Padjadjaran School of Medicine, Hasan Sadikin Hospital Bandung IndonesiaDepartment of Cardiology and Vascular Medicine,Siloam Hospitals Lippo Village-Faculty of Medicine, Universitas Pelita Harapan Tangerang IndonesiaDepartment of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan Kita Jakarta IndonesiaDepartment of Cardiology and Vascular Medicine, Diponegoro University, Kariadi Hospital Semarang Indonesia;Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin Makassar IndonesiaDepartment of Cardiology and Vascular Medicine, Faculty of Medicine Airlangga University, Soetomo Hospital Surabaya IndonesiaWorldwide, ischemic heart disease is the most common cause of death and its frequency is increasing. ST-segment elevation myocardial infarction or STEMIis as form of ischemic heart disease with the highest mortality rate. Based on ESC (European Society of Cardiology) guideline 2017 for STEMI management, reperfusion therapywhich is primary PCI strategy is recommended over fibrinolysis within induced timeframes, but if timely primary PCI cannot be performed after STEMI diagnosis, fibrinolytic therapy is recommended within 12 hours of symptom onset in patients without contraindications. In fibrinolytic therapy, oral aspirin should be given, and Clopidogrel is indicated as an addition to aspirin. Although Clopidogrel is a recommended P2Y12receptor inhibitorin fibrinolytic therapy,PERKI guideline 2018 in ACS management also mention thatswitching to Ticagrelor can be considered in patients whowillundergo PCI treatmentafter fibrinolytic. In PLATO study, patients who have acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke. However, patients who received fibrinolytic therapy within 24 hours before randomization were excluded. WhileinSET-FAST study, Ticagrelor provides more prompt and potent platelet inhibition compared with Clopidogrel in patients undergoing PCI within 24 hours of receiving fibrinolysis for STEMI. TREAT study was conducted to evaluate the safety of ticagrelor in STEMI patients receiving fibrinolytic therapy within 24 hours.TREAT study concluded, at 30 days observation, in patients younger than 75 years with STEMI, delayed administration of Ticagrelor after fibrinolytic therapy was noninferior to Clopidogrel for TIMI major bleeding. Based on the result from PLATO study and preliminary TREAT study result on 30 days, the use of Ticagrelor within 24 hours after fibrinolytic therapy can be considered with comparable safety profile to Clopidogrel. Keywords: STEMI, fibrinolysis, ticagrelorhttp://ijconline.id/index.php/ijc/article/view/915STEMI, fibrinolysis, ticagrelor |
| spellingShingle | Daniel Tobing Dafsah Juzar Achmad Fauzi Yahya Antonia Anna Lukito Doni Firman Sodiqur Rifqi Abdul Hakim Alkatiri Rurus Suryawan The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients Majalah Kardiologi Indonesia STEMI, fibrinolysis, ticagrelor |
| title | The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients |
| title_full | The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients |
| title_fullStr | The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients |
| title_full_unstemmed | The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients |
| title_short | The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients |
| title_sort | role of ticagrelor in stemi fibrinolytic and its rationale to utilize for indonesian patients |
| topic | STEMI, fibrinolysis, ticagrelor |
| url | http://ijconline.id/index.php/ijc/article/view/915 |
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