Related Experiment Video
Updated: Aug 6, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
State of the Art: Personalized Antiplatelet Therapy by Genotype and Platelet Function Testing
Paul A Gurbel1, Young-Hoon Jeong2, Eliano Navarese3,4
1Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore and Lifebridge Health System, Baltimore, Maryland, USA.
Insights
Personalized antiplatelet therapy using P2Y12 inhibitors balances thrombotic risk and bleeding. Objective testing helps clinicians tailor treatment, moving beyond a one-size-fits-all approach for patients with coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Hematology
Background:
- The P2Y12 receptor on platelets is crucial in arterial thrombosis.
- Clopidogrel resistance and high platelet reactivity are linked to recurrent ischemic events in coronary artery disease patients.
- This led to the development of potent P2Y12 inhibitors.
Purpose of the Study:
- To review the evidence for personalized P2Y12 inhibitor therapy.
- To discuss the balance between antiplatelet efficacy and bleeding risk.
- To guide clinicians in choosing between standardized and personalized antiplatelet strategies.
Main Methods:
- Review of existing evidence on P2Y12 receptor inhibitors.
- Analysis of clopidogrel resistance and potent inhibitor outcomes.
- Discussion of therapeutic window concept for personalized therapy.
Main Results:
- A 'one size fits all' clopidogrel strategy increases thrombotic risk compared to potent inhibitors.
- Potent P2Y12 inhibitors increase bleeding risk.
- Personalized therapy aims to optimize the balance between preventing thrombosis and minimizing bleeding.
Conclusions:
- Personalized antiplatelet therapy, guided by objective testing, offers a potential advantage over standardized approaches.
- The concept of a therapeutic window is key to balancing efficacy and safety.
- Clinicians must weigh evidence to decide on individualized P2Y12 inhibitor treatment.
Abstract:
The platelet P2Y12 receptor plays a critical role in the genesis of arterial thrombotic events. The demonstration of clopidogrel resistance and the relation of high platelet reactivity to ADP to recurrent ischemic event occurrences in patients with coronary artery disease treated with stents significantly influenced the development of potent P2Y12 receptor inhibitors. A "one size fits all" strategy of clopidogrel therapy is associated with a greater risk for recurrent thrombotic events compared to uniform use of potent P2Y12 receptor inhibitors which causes more bleeding. The concept of a therapeutic window for P2Y12 inhibitor therapy that strikes a balance between the attenuation of thrombotic risk and bleeding has been used to personalize antiplatelet therapy. Despite the absence of a strong recommendation in the current guidelines for platelet function testing or genetic testing, the treating interventionalist must rely on the available evidence base, as summarized in this Review, to help decide whether to employ a one-size-fits-all strategy of antiplatelet therapy or one that is personalized by objective testing.
Related Concept Videos
01:29Pharmacogenomics: Identification of New Drug Targets
01:27Peripheral Artery Disease III: Interprofessional Care
01:11Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase
01:29Pharmacogenetics and Pharmacogenomics: Overview