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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Novel approaches to P2Y12 inhibition and aspirin dosing
William A E Parker1,2, Robert F Storey1,2
1Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield , Sheffield, UK.
Insights
Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors is common for atherothrombotic conditions. Research explores new P2Y12 inhibitors and aspirin dosing to improve efficacy and reduce bleeding risks.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis
Background:
- Dual antiplatelet therapy (DAPT) using aspirin and P2Y12 inhibitors is standard for atherothrombotic diseases.
- Despite DAPT's benefits in acute coronary syndromes, residual ischemic risk and bleeding complications persist.
- Investigating novel antiplatelet strategies is crucial for optimizing patient outcomes.
Purpose of the Study:
- To review current antiplatelet therapies, including dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors.
- To explore emerging P2Y12 inhibitors like selatogrel and novel aspirin dosing strategies.
- To assess potential improvements in efficacy and safety profiles of antiplatelet treatments.
Main Methods:
- Review of recent clinical trials and studies on antiplatelet agents.
- Analysis of data concerning ticagrelor monotherapy and new agents like selatogrel.
- Examination of pharmacokinetic and pharmacodynamic data for varying aspirin dosages.
Main Results:
- Ticagrelor monotherapy shows promise in specific settings like percutaneous coronary intervention (PCI).
- Selatogrel, a novel subcutaneous P2Y12 inhibitor, demonstrated potent effects in early studies.
- Very-low-dose, twice-daily aspirin regimens are being investigated for potential benefits in DAPT.
Conclusions:
- Optimizing antiplatelet therapy requires exploring new P2Y12 inhibitors and aspirin dosing.
- Balancing antithrombotic efficacy with reduced bleeding risk remains a key challenge.
- Further research into novel agents and regimens like selatogrel and low-dose aspirin is warranted.
Abstract:
Aspirin and P2Y12 inhibitors remain commonly prescribed antiplatelet drugs in the treatment of atherothrombotic conditions. Despite established benefits of dual antiplatelet therapy (DAPT) in the setting of acute coronary syndromes, there remains residual ischemic risk in this group and the problem of bleeding complications is an ongoing issue. DAPT with aspirin and ticagrelor has now been studied in other patient groups such as those with concurrent diabetes and stable coronary artery disease, and those undergoing elective percutaneous coronary intervention (PCI). Recent trials of ticagrelor monotherapy have suggested this may have benefits over standard-of-care in some settings, such as PCI, but not in others such as peripheral arterial disease or stroke. A novel subcutaneously administered P2Y12 inhibitor, selatogrel, has shown powerful, rapid and consistent effect in a phase 2 study. Aspirin dosing remains an area of investigation, particularly in the setting of DAPT. A novel regimen of very-low-dose twice-daily aspirin has hypothetical advantages in pharmacodynamic and pharmacokinetic effects, maintaining antiplatelet effect whilst reducing potentially harmful peak-trough variation.
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