Personalizing antiplatelet therapies: What have we learned from recent trials?

Abstract

Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist is currently the standard of care for the prevention of ischemic events in patients with acute coronary syndrome or undergoing percutaneous coronary intervention. Several studies have shown that not all patients benefit from the treatment to the same degree and demonstrated that high on-treatment platelet reactivity may be associated with an increased risk of thrombotic events, while low on-treatment platelet reactivity may be linked to a higher risk of bleeding. Personalized antiplatelet treatment strategies based on platelet function monitoring and genetic testing constitute a promising tool for the prevention of both stent thrombosis and bleeding events, but conclusive evidence that such approaches can improve clinical outcomes is lacking. This review presents the most recent studies on tailored antiplatelet therapy in the management of coronary heart disease, with a focus on the prognosis value of platelet function testing.

Keywords:

• Antiplatelet therapy
• Individualized therapy
• P2Y12 receptor antagonists
• Platelet function testing
• Major Adverse Cardiovascular Events

Funding

ML is a Fonds de recherche du Québec - Santé (FRQS) Research Scholar [award number 33048]. JFT has received in-kind and financial support for physician-initiated grants from Spartan Bioscience Inc (manufacturer of the Spartan RX CYP2C19), Roche Diagnostics (manufacturer of MultiplateTM), Aggredyne (manufacturer of AggreguideTM), and Eli Lilly Canada (manufacturer of prasugrel); received honorarium for speaker/consultation fees/advisory boards from AstraZeneca (manufacturer of ticagrelor) and Eli Lilly (manufacturer of prasugrel). ML has received in-kind and financial support for investigator-initiated grants from Roche Diagnostics (manufacturer of MultiplateTM) and Aggredyne (manufacturer of AggreguideTM).

Additional information

Funding

ML is a Fonds de recherche du Québec - Santé (FRQS) Research Scholar [award number 33048]. JFT has received in-kind and financial support for physician-initiated grants from Spartan Bioscience Inc (manufacturer of the Spartan RX CYP2C19), Roche Diagnostics (manufacturer of MultiplateTM), Aggredyne (manufacturer of AggreguideTM), and Eli Lilly Canada (manufacturer of prasugrel); received honorarium for speaker/consultation fees/advisory boards from AstraZeneca (manufacturer of ticagrelor) and Eli Lilly (manufacturer of prasugrel). ML has received in-kind and financial support for investigator-initiated grants from Roche Diagnostics (manufacturer of MultiplateTM) and Aggredyne (manufacturer of AggreguideTM).