Precision Medicine in Interventional Cardiology: Implications for Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

Abstract

Precision medicine is a medical model that proposes the customization of medical treatments to the individual patient, as opposed to a one-drug-fits-all model. Such a “personalized medicine” approach has been widely adopted in several medical fields, such as cancer medicine, but the implementation of precision medicine in cardiovascular medicine has not been similarly straightforward. Because pharmacogenomics plays an important role in the safety and efficacy of cardiovascular drug therapy, there has been a great interest in the use of tools aiming at personalizing antiplatelet therapy. Moreover, antiplatelet therapy is essential for the treatment of cardiovascular patients to reduce the risk of thrombotic complications, particularly those undergoing percutaneous coronary intervention, but it is inevitably associated with increased bleeding risk. In this review, the authors discuss the rationale, summarize the evidence and discuss the current and future directions for the personalization of antiplatelet treatment regimens in patients undergoing percutaneous coronary intervention.

Keywords::

• antiplatelet therapy
• genetic tests
• percutaneous coronary intervention
• platelet function testing
• precision medicine

Acknowledgments

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Financial & competing interests disclosure

M Galli declares that he has received payment as an individual for a consulting fee or an honorarium from Terumo. F Franchi declares that he has received payment as an individual for a consulting fee or an honorarium from AstraZeneca, Bayer and Sanofi, as well as institutional payments for grants from PLx Pharma and the Scott R. MacKenzie Foundation. DJ Angiolillo declares that he has received consulting fees or honoraria from Abbott, Amgen, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol Myers Squibb, Chiesi, Daiichi-Sankyo, Eli Lilly, Haemonetics, Janssen, Merck, PhaseBio, PLx Pharma, Pfizer and Sanofi. DJ Angiolillo also declares that his institution has received research grants from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Matsutani Chemical Industry Co., Merck, Novartis, Osprey Medical, Renal Guard Solutions and the Scott R. MacKenzie Foundation. L Ortega-Paz is supported by a grant from the Spanish Society of Cardiology (SEC/MHE-MOV-INT 20/001). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

M Galli declares that he has received payment as an individual for a consulting fee or an honorarium from Terumo. F Franchi declares that he has received payment as an individual for a consulting fee or an honorarium from AstraZeneca, Bayer and Sanofi, as well as institutional payments for grants from PLx Pharma and the Scott R. MacKenzie Foundation. DJ Angiolillo declares that he has received consulting fees or honoraria from Abbott, Amgen, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol Myers Squibb, Chiesi, Daiichi-Sankyo, Eli Lilly, Haemonetics, Janssen, Merck, PhaseBio, PLx Pharma, Pfizer and Sanofi. DJ Angiolillo also declares that his institution has received research grants from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Matsutani Chemical Industry Co., Merck, Novartis, Osprey Medical, Renal Guard Solutions and the Scott R. MacKenzie Foundation. L Ortega-Paz is supported by a grant from the Spanish Society of Cardiology (SEC/MHE-MOV-INT 20/001). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.