Antiplatelet Therapy for Atherothrombotic Disease in 2022—From Population to Patient-Centered Approaches

Abstract

Antiplatelet agents, with aspirin and P2Y12 receptor antagonists as major key molecules, are currently the cornerstone of pharmacological treatment of atherothrombotic events including a variety of cardio- and cerebro-vascular as well as peripheral artery diseases. Over the last decades, significant changes have been made to antiplatelet therapeutic and prophylactic strategies. The shift from a population-based approach to patient-centered precision medicine requires greater awareness of individual risks and benefits associated with the different antiplatelet strategies, so that the right patient gets the right therapy at the right time. In this review, we present the currently available antiplatelet agents, outline different management strategies, particularly in case of bleeding or in perioperative setting, and develop the concept of high on-treatment platelet reactivity and the steps toward person-centered precision medicine aiming to optimize patient care.

A Sticky Situation: Variable Agreement Between Platelet Function Tests Used to Assess Anti-platelet Therapy Response

“…There was moderate to strong positive correlation in measurement units among the P2Y12-I response tests (r = 0.57-0.86), but a lack of correlation observed in measurement units among the ASA response tests (r = 0.02-0.32, but all with p > 0.05). The variability in agreement and correlation is similar to other studies comparing multiple PFT platforms for ASA and P2Y12-I response (16)(17)(18)(19)(20), and likely attributable to the differences in methodology underlying each testing platform and the lack of standardized laboratory definitions for adequate platelet suppression in response to DAPT (11,21).…”

“…Given the strong correlation in measurement units for P2Y12-I response (r = 0.65-0.75), there is potential for improved agreement between LTA and WBA with modification of cut-off values used for interpretation, particularly those driven by integration with clinical outcomes. The VerifyNow PRU Test has been widely adopted due to its ease of use as a waived, point-of-care test, and the ability to compare results across laboratories and health-systems (3,21). Specifically, VerifyNow testing has enabled establishment of cut-off values for drug efficacy, which have been supported by multiple clinical trials of PFT-guided antiplatelet therapy in cardiac patients post-PCI (7).…”

Perspective: Collagen induced platelet activation via the GPVI receptor as a primary target of colchicine in cardiovascular disease

“…COX-1 and P2Y 12 inhibition have been the cornerstones of antiplatelet therapy for cardiovascular disease for several decades ( 6 , 22 , 23 ). While dual antiplatelet therapy (e.g., aspirin and clopidogrel) has proven to be effective in reducing cardiovascular events in unstable angina pectoris patients and post PCI ( 24 , 25 ), this treatment has some limitations such as residual high on-treatment platelet reactivity to ADP ( 26 ) and the bleeding complications caused by more potent P2Y 12 inhibitors ( 27 ).…”

Upgulation of lncRNA GASL1 inhibits atherosclerosis by regulating miR-106a/LKB1 axis

“…Multiple imaging and histological studies have confirmed that such plaques are “unstable plaques”, which are prone to rupture and fall off, triggering acute cerebrovascular embolism [ 4 ]. Although the progress of carotid atherosclerotic plaques and the formation of unstable plaques are related to traditional factors such as hypertension, hyperlipidemia, and smoking, there are still many patients with carotid stenosis who do not have traditional risk factors and suddenly suffer from transient amaurosis, TIA, stroke and other acute cerebral ischemia symptoms [ 5 , 6 ]. Therefore, further exploration of biomarkers for AS contributes to the treatment of such patients.…”