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Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A

Lukasz Koltowski1, Mariusz Tomaniak, Daniel Aradi

  • 11st Department of Cardiology, Medical University of Warsaw, Poland, Poland. lukasz@koltowski.com.

Cardiology Journal
|March 11, 2017
PubMed

Insights

Personalized dual antiplatelet therapy (DAPT) using genotyping or platelet function testing improves platelet inhibition in stable coronary artery disease patients after percutaneous coronary intervention. This approach may reduce cardiovascular risk by optimizing antiplatelet response.

Area of Science:

  • Cardiology
  • Pharmacogenomics
  • Interventional Cardiology

Background:

  • Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI) for stable coronary artery disease (SCAD).
  • Suboptimal platelet inhibition affects one-third of patients, increasing cardiovascular risk.
  • The ONSIDE TEST study investigated personalized DAPT strategies.

Purpose of the Study:

  • To evaluate the clinical impact of personalized DAPT strategies in SCAD patients undergoing PCI.
  • To assess the effectiveness of point-of-care genotyping and platelet function testing in guiding DAPT.
  • To compare personalized DAPT with standard care regarding cardiovascular outcomes.

Main Methods:

  • Fifty SCAD patients undergoing PCI were randomized into three groups: genotyping, platelet function testing (PFT), and control.
  • Genotyping utilized the Spartan RX CYP2C19 System; PFT used the VerifyNow P2Y12 assay.
  • Inadequate clopidogrel response prompted prasugrel administration; periprocedural myocardial injury (PMI) was the primary endpoint.

Main Results:

  • Poor clopidogrel metabolizers were identified in 32% (genotyping arm) and 13% (PFT arm).
  • Periprocedural platelet reactivity was significantly lower in the genotyping (80 ± 49.0 PRU) and PFT (36.5 ± 47 PRU) arms compared to control (176 ± 67.8 PRU).
  • Periprocedural myocardial injury (PMI) occurred in 37% of the total study population.

Conclusions:

  • Personalized DAPT strategies, guided by genotyping or PFT, enhance platelet inhibition in SCAD patients post-PCI.
  • These personalized approaches are feasible for integration into clinical practice.
  • Monitoring PMI rates is crucial for comparing DAPT strategies.
Abstract

Keywords:
clopidogrelpharmacotherapy individualizationplatelet aggregation inhibitorsplatelet testingprasugrel

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