Dual antiplatelet therapy with aspirin and a P2Y(12) 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 P2Y(12) inhibitors (clopidogrel, prasugrel, ticagrelor) has enabled
physicians to contemplate switching among therapies because of specific clinical scenarios.
The recent introduction of an intravenous P2Y(12) 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 P2Y(12) 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 P2Y(12) inhibitors, different modalities
and definitions of switching, and available literature and recommendations for switching
between P2Y(12) inhibitors.
