Antiplatelet Therapy in 2026: P2Y12 and COX Inhibition in Cardiogenic Shock: A Narrative Review

Antiplatelet therapy is critical in patients with acute coronary syndromes experiencing cardiogenic shock (CS) to prevent stent thrombosis and reduce the risk of major adverse cardiac events. Its role is particularly important after percutaneous revascularization; however, the pharmacokinetic and pharmacodynamic effects of antiplatelet therapy may be significantly altered in patients who experience CS. This narrative review discusses the pathophysiologic changes associated with CS that affect antiplatelet agents and provides a concise overview of the related literature on P2Y12 inhibitor selection and the role of aspirin after percutaneous revascularization in this high-risk population.