Does one size really fit all? The case for personalized antiplatelet therapy in interventional cardiology

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• Cardiovascular disease remains the leading global cause of mortality.
• Dual antiplatelet therapy (DAPT), combining aspirin and a P2Y12 inhibitor, is the standard treatment post-acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI).
• Current DAPT protocols face challenges regarding aspirin's necessity, optimal duration post-drug-eluting stent (DES) implantation, P2Y12 inhibitor selection, and individual patient response variability.

Purpose of the Study:

• To evaluate the efficacy and safety of current DAPT strategies.
• To explore the potential benefits of P2Y12 inhibitor monotherapy.
• To question the "one-size-fits-all" approach and advocate for personalized antiplatelet therapy strategies.

Main Methods:

• Review of recent clinical data and guidelines on DAPT and P2Y12 inhibitor monotherapy.
• Analysis of anti-ischemic effects and bleeding risks associated with different antiplatelet regimens.
• Comparative assessment of current DAPT duration recommendations and P2Y12 inhibitor choices.

Main Results:

• Emerging evidence suggests P2Y12 inhibitor monotherapy may provide sufficient anti-ischemic benefits while significantly lowering bleeding risk.
• Inconsistencies in DAPT duration guidelines and P2Y12 inhibitor selection create uncertainty in clinical practice.
• Individual patient responses to antiplatelet agents vary, highlighting limitations of uniform treatment protocols.

Conclusions:

• The current default DAPT strategy may not be optimal for all patients.
• A personalized approach to antiplatelet therapy, potentially involving P2Y12 inhibitor monotherapy, warrants further investigation.
• Tailoring treatment based on individual patient factors and response is crucial for optimizing outcomes in cardiovascular disease management.