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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Optimizing antiplatelet therapy following percutaneous coronary intervention: clinical pathways for platelet function
Tom A Lassar1, Daniel I Simon, Kevin Croce
1Department of Medicine, Case Western Reserve School of Medicine, Cleveland, OH, USA.
Reviews in Cardiovascular Medicine
|November 15, 2011
Summary
Dual antiplatelet therapy (DAPT) reduces cardiovascular events but clopidogrel variability exists. Personalized antiplatelet strategies using newer agents or platelet function testing can improve outcomes for patients undergoing percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard for acute coronary syndrome and following percutaneous coronary intervention (PCI).
- DAPT reduces stent thrombosis and major adverse cardiovascular events (MACE).
Observation:
- Significant interindividual variability exists in platelet inhibition with clopidogrel, a common P2Y12 antagonist.
- High on-treatment platelet activity (hyporesponsiveness) during clopidogrel therapy is linked to increased adverse cardiovascular events post-PCI.
Findings:
- Personalized antiplatelet therapy, guided by algorithms or platelet function testing, has the potential to reduce MACE and stent thrombosis.
- Novel potent antiplatelet agents like prasugrel and ticagrelor offer alternative treatment options.
Implications:
- Implementing "test and treat-to-target" strategies can optimize antiplatelet therapy effectiveness.
- Tailoring antiplatelet regimens based on individual patient response may improve safety and efficacy following PCI.
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