Do we need a new P2Y12 receptor antagonist ?

This editorial refers to ‘Pharmacodynamics, pharmacokinetics, and safety of single-dose subcutaneous administration of selatogrel, a novel P2Y₁₂ receptor antagonist, in patients with chronic coronary syndromes’, by R.F. Storey et al..

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In recent years, success has been achieved in decreasing the time from first medical contact to antiplatelet therapy preceding mechanical reperfusion of AMI. It has involved emergency departments and mobile intensive care units first in clinical trials and now in daily practice. Stronger and faster platelet inhibition has also been obtained with the new generation of P2Y₁₂ inhibitors as well as with the new modes of administration (crushed or orodispersible tablets, intravenous cangrelor). The chain of care cannot expect much better clinical outcomes with selatogrel. In contrast, the time from symptom onset to first medical contact, i.e. a waiting time free of any intervention to block the ongoing platelet-mediated event, has not changed much in the past years. This period belongs to the patients and their surroundings. Information and education should allow the patients to recognize the symptoms likely to correspond to the start of an MI and call for emergency help. Selatogrel, a P2Y₁₂ inhibitor that can be self-administered subcutaneously, should be tested in the first minutes of AMI to see whether it aborts or at least reduces MI and possibly prevents cardiogenic shock, heart failure, arrythmias, or death (Take home figure). This will be the challenge of the phase III trial involving the patient directly in the process of coronary reperfusion. So, doctors may consider they do not need a new P2Y₁₂ inhibitor like selatogrel whereas patients really need it and it may help to demonstrate that early self-administered antiplatelet therapy is an effective first-aid procedure in the case of a heart attack.