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Updated: Oct 9, 2025
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Published on: March 15, 2022
Role of platelet function and genetic testing in patients undergoing percutaneous coronary intervention
Mattia Galli1, Francesco Franchi2, Fabiana Rollini2
1Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, United States; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
Insights
Personalizing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) using platelet function or genetic testing can optimize treatment. This approach aims to balance preventing blood clots and reducing bleeding risks for individual patients.
Area of Science:
- Cardiology
- Pharmacogenomics
- Clinical Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is standard post-percutaneous coronary intervention (PCI).
- A uniform DAPT approach may lead to suboptimal efficacy or excessive bleeding in certain patient groups.
- Interindividual variability in P2Y12 inhibitor response affects clinical outcomes and healthcare resource utilization.
Purpose of the Study:
- To review the rationale and evidence for guided antiplatelet therapy selection in PCI patients.
- To explore the implications of platelet function and genetic testing in modern PCI practice.
- To discuss strategies for balancing ischemic and bleeding events at the individual patient level.
Main Methods:
- Review of current literature on platelet function testing and genetic testing for guiding P2Y12 inhibitor selection.
- Analysis of studies evaluating the clinical impact of guided versus standard DAPT regimens.
- Exploration of the role of pharmacogenetics and pharmacodynamics in antiplatelet therapy.
Main Results:
- Guided selection of P2Y12 inhibitors shows promise in optimizing the balance between ischemic and bleeding events.
- Platelet function and genetic testing can identify patients at high risk for adverse events on standard DAPT.
- Personalized antiplatelet strategies may improve outcomes and resource utilization in PCI patients.
Conclusions:
- Guided antiplatelet therapy represents a promising strategy to personalize treatment for patients undergoing PCI.
- Platelet function and genetic testing offer valuable tools for tailoring DAPT regimens.
- Further research and clinical implementation are warranted to optimize patient care and outcomes in PCI.
Abstract:
Dual antiplatelet therapy (DAPT) represents the standard of care for patients undergoing percutaneous coronary intervention (PCI). Increasing evidence indicates that a "one-size-fits-all" approach with the use of a standard DAPT regimen for all patients undergoing PCI could lead to either suboptimal efficacy or prohibitively high bleeding in specific cohorts of patients. Moreover, the broad interindividual variability in response to P2Y12 inhibitors can impact outcomes and resource utilization. Among the strategies proposed to provide a more balanced trade-off between bleeding and ischemic events at a single patient level, a guided selection of P2Y12 inhibitors, by using platelet function or genetic testing, has shown promising results. In this review, we provide a focused summary of the rationale and evidence on the use of platelet function and genetic testing-guided antiplatelet therapy, and we explore the implications for their use in the modern setting of patients undergoing PCI.
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