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Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention. [Review]

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Citation: Jacc: Cardiovascular Interventions. 12(16):1521-1537, 2019 08 26.PMID: 31202949Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Blood Platelets/de [Drug Effects] | *Coronary Thrombosis/pc [Prevention & Control] | *Cytochrome P-450 CYP2C9/ge [Genetics] | *Percutaneous Coronary Intervention | *Pharmacogenomic Testing/st [Standards] | *Pharmacogenomic Variants | *Platelet Aggregation Inhibitors/ad [Administration & Dosage] | *Platelet Function Tests/st [Standards] | *Purinergic P2Y Receptor Antagonists/ad [Administration & Dosage] | *Receptors, Purinergic P2Y12/de [Drug Effects] | Blood Platelets/me [Metabolism] | Clinical Decision-Making | Consensus | Coronary Thrombosis/bl [Blood] | Coronary Thrombosis/ge [Genetics] | Cytochrome P-450 CYP2C9/me [Metabolism] | Dual Anti-Platelet Therapy | Hemorrhage/ci [Chemically Induced] | Humans | Patient Selection | Percutaneous Coronary Intervention/ae [Adverse Effects] | Platelet Aggregation Inhibitors/ae [Adverse Effects] | Platelet Aggregation Inhibitors/pk [Pharmacokinetics] | Precision Medicine/st [Standards] | Predictive Value of Tests | Purinergic P2Y Receptor Antagonists/ae [Adverse Effects] | Purinergic P2Y Receptor Antagonists/pk [Pharmacokinetics] | Receptors, Purinergic P2Y12/me [Metabolism] | Risk Factors | Treatment OutcomeYear: 2019 Local holdings: Available online through MWHC library: 2008 - presentISSN:

1936-8798

Name of journal: JACC. Cardiovascular interventionsAbstract: Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the standard treatment for patients undergoing percutaneous coronary intervention. The availability of different P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment regimens, which may include escalation or de-escalation of P2Y12-inhibiting therapy. Indeed, individualized and alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early- vs. long-term treatment), and patient risk for ischemic and bleeding complications. A tailored DAPT approach may be potentially guided by platelet function testing (PFT) or genetic testing. Although the routine use of PFT or genetic testing in percutaneous coronary intervention-treated patients is not recommended, recent data have led to an update in guideline recommendations that allow considering selective use of PFT for DAPT de-escalation. However, guidelines do not expand on when to implement the selective use of such assays into decision making for personalized treatment approaches. Therefore, an international expert consensus group of key leaders from North America, Asia, and Europe with expertise in the field of antiplatelet treatment was convened. This document updates 2 prior consensus papers on this topic and summarizes the contemporary updated expert consensus recommendations for the selective use of PFT or genotyping in patients undergoing percutaneous coronary intervention. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.All authors: Alexopoulos D, Angiolillo DJ, Aradi D, Bhatt DL, Bonello L, Collet JP, Cuisset T, Franchi F, Gross L, Gurbel P, Jeong YH, Mehran R, Moliterno DJ, Neumann FJ, Pereira NL, Price MJ, Sabatine MS, Sibbing D, So DYF, Stone GW, Storey RF, Tantry U, Ten Berg J, Trenk D, Valgimigli M, Waksman ROriginally published: Jacc: Cardiovascular Interventions. 12(16):1521-1537, 2019 Aug 26.Fiscal year: FY2020Digital Object Identifier:

https://dx.doi.org/10.1016/j.jcin.2019.03.034

Date added to catalog: 2019-10-10

Holdings ( 1 )
Title notes ( 3 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	31202949	Available		31202949

Available online through MWHC library: 2008 - present

Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the standard treatment for patients undergoing percutaneous coronary intervention. The availability of different P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment regimens, which may include escalation or de-escalation of P2Y12-inhibiting therapy. Indeed, individualized and alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early- vs. long-term treatment), and patient risk for ischemic and bleeding complications. A tailored DAPT approach may be potentially guided by platelet function testing (PFT) or genetic testing. Although the routine use of PFT or genetic testing in percutaneous coronary intervention-treated patients is not recommended, recent data have led to an update in guideline recommendations that allow considering selective use of PFT for DAPT de-escalation. However, guidelines do not expand on when to implement the selective use of such assays into decision making for personalized treatment approaches. Therefore, an international expert consensus group of key leaders from North America, Asia, and Europe with expertise in the field of antiplatelet treatment was convened. This document updates 2 prior consensus papers on this topic and summarizes the contemporary updated expert consensus recommendations for the selective use of PFT or genotyping in patients undergoing percutaneous coronary intervention. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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