Table 3.

Pharmacological properties of oral antithrombotic therapy in/after STEMI

	Aspirin	Clopidogrel	Prasugrel	Ticagrelor	Vorapaxar	Rivaroxaban
Target	COX1	P2Y12 receptor	P2Y12 receptor	P2Y12 receptor	PAR1	Factor Xa
Type of blockade	Irreversible	Irreversible	Irreversible	Reversible	Reversible	Reversible
Dose	150–325 mg LD; 81–100 mg once-daily MD	600 mg LD; 75 mg once-daily MD	60 mg LD; 10 mg once-daily MD	180 mg LD; 90 mg twice-daily MD	2.08 mg once-daily MD	2.5 mg twice-daily MD
Prodrug	No	Yes	Yes	No	No	No
Onset of action	60 min	2–8 h	30 min–4 h	30 min–4 h	>12 h||	2–4 h
Offset of action	7–10 days	7–10 days	7–10 days	3–5 days	4–8 weeks	12 h
Drug interactions	NSAIDs	CYP2C19 inhibitors	No	CYP3A inhibitors or inducers, drugs using P‑glycoprotein transporter	CYP3A inhibitors or inducers, drugs using P‑glycoprotein transporter	CYP3A4 inhibitors or inducers, P‑glycoprotein transporter inhibitors
Timing of administration	Immediately after presentation	At presentation or at time of primary PCI	At presentation or at time of primary PCI	At presentation or at time of primary PCI	After stabilisation	After stabilisation (>24 h after admission)
Contraindications	Hypersensitivity	Hypersensitivity, active pathological bleeding	Prior CVA, high risk of bleeding, hypersensitivity	Prior ICH, high risk of bleeding, severe hepatic dysfunction, hypersensitivity	Prior ICH or CVA, high risk of bleeding, hypersensitivity	Prior CVA, CrCl <15 ml/min, high bleeding risk, severe hepatic dysfunction, treatment with other anticoagulant, hypersensitivity

STEMI ST-elevation myocardial infarction, COX1 cyclo-oxygenase-1, PAR-1 protease-activated receptor-1, LD loading dose, MD maintenance dose, NSAIDs non-steroidal anti-inflammatory drugs, PCI percutaneous coronary intervention, CVA cerebrovascular accident, ICH intracerebral haemorrhage, CrCl creatinine clearance