De-Escalation of Treatment With Oral P2Y12 Receptor Inhibitors: Current Status and Perspectives

Alexopoulos, Dimitrios; Lianos, Ioannis; Vlachakis, Panagiotis; Sfantou, Danai; Dragona, Vassiliki-Maria; Varlamos, Charalampos

doi:10.1177/1074248418823724

Cited by 5 publications

(3 citation statements)

References 60 publications

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“…22 Clinical practice guidelines now recommend preferential use of prasugrel or ticagrelor in ACS patients undergoing PCI, 2 though clopidogrel remains the most widely prescribed P2Y 12 inhibitor and the only agent indicated for PCI in the setting of stable disease. 9 As a consequence, use of prasugrel or ticagrelor early after PCI, when the risk for ischemic events is highest, followed by de-escalation to clopidogrel maintenance therapy to reduce bleeding risk and lower medication costs has become more common in practice; 11,12,23 however, the safety and effectiveness of empiric de-escalation remains unclear and studies have yielded conflicting results. 16,24 Biomarker-guided strategies offer the potential to more precisely direct de-escalation and improve clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Frequency and clinical outcomes of CYP2C19 genotype-guided escalation and de-escalation of antiplatelet therapy in a real-world clinical setting

Martin

Williams

Klein

et al. 2020

Genetics in Medicine

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Purpose-To evaluate the frequency and clinical impact of switches in antiplatelet therapy following implementation of CYP2C19 genotyping after percutaneous coronary intervention (PCI). Methods-The frequency of escalation (clopidogrel switched to prasugrel/ticagrelor) and deescalation (prasugrel/ticagrelor switched to clopidogrel) was evaluated in 1063 PCI patients who underwent CYP2C19 genotyping. Risk of major adverse cardiovascular or cerebrovascular (MACCE) and bleeding events over one-year was evaluated. Results-Antiplatelet therapy switches were common (19%), with escalation (101/115: 88%) and de-escalation (77/84: 92%) occurring predominantly in patients with and without a CYP2C19 nonfunctional allele, respectively. Nonfunctional allele carriers initiated and continued on clopidogrel had a significantly higher risk of experiencing either a MACCE or bleeding event Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

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Section: Introductionmentioning

confidence: 99%

Frequency and clinical outcomes of CYP2C19 genotype-guided escalation and de-escalation of antiplatelet therapy in a real-world clinical setting

Martin

Williams

Klein

et al. 2020

Genetics in Medicine

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“…Current published data report positive yet inconclusive evidence regarding the prognostic effects of switching to clopidogrel [24,25]. Some studies enhance the argument of reduction in bleeding events with or without improved clinical efficacy [26,27], while others indicate that there is non-significant difference in terms of major bleeding, cardiovascular events and all-cause death [28].…”

Section: Fig 3 Kaplan-meier Curves Of Major Adverse Cardiovascular Ev...mentioning

confidence: 99%

Potent P2Y12 inhibitors versus clopidogrel to predict adherence to antiplatelet therapy after an acute coronary syndrome: insights from IDEAL-LDL

Kourti¹,

Konstantas²,

Farmakis³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Superiority of potent P2Y12 inhibitors over clopidogrel after an acute coronary syndrome (ACS) has been well established, however potent P2Y12 inhibition is responsible for more adverse events, which may influence patient adherence to treatment. Aim of the present study is to investigate the adherence to the prescribed P2Y12 inhibitor (P2Y12i) in patients on dual antiplatelet therapy (DAPT) after an ACS. Methods: In an IDEAL-LDL trial substudy, we included 344 patients after ACS discharged on DAPT. The primary outcome was the difference between potent P2Y12i and clopidogrel in terms of adherence, as well as other predictors of adherence to the antiplatelet regimen. Secondary outcomes included the prevalence of DAPT continuation and its predictors and the antiplatelet regimen selection after DAPT. Results: Adherence to the potent P2Y12i and to clopidogrel was observed in 140/178 (78.7%) and 111/166 (66.9%) patients (p = 0.016), respectively. In the multivariate model, after adjustment for P2Y12i switching during the first year of therapy, there was no difference observed in adherence between potent P2Y12i and clopidogrel (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.55-1.74). Significant predictors included history of cardiovascular disease (CVD) (OR = 0.51, 95% CI = 0.31-0.86) and percutaneous coronary intervention (PCI) index event treatment (OR = 2.58, 95% CI = 1.38-4.82). Of patients, 72% continued DAPT >12 months and female gender was a negative predictor of DAPT prolongation (adjusted OR = 0.43, 95% CI = 0.21-0.90). DAPT was continued until the end of follow-up in 42.7%, while 54.6% resumed with single antiplatelet regimen. Conclusions: Adherence to DAPT was not affected by the P2Y12i potency, whereas history of CVD and PCI treatment were associated with reduced and increased adherence, respectively. Clinical Trial Registration: NCT02927808, https://clinicaltrials.gov/ct2/show/NCT02927808.

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“…9 As a result, treatment de-escalation has also been proposed as a potentially beneficial strategy for patients at a high risk of bleeding. 25 Several methods of PFT are available for the ex vivo measurement of platelet reactivity to adenosine diphosphate, including point-of-care assays (e.g. the VerifyNow P2Y 12 system [Werfen], the Multiplate analyzer [Roche], and thromboelastography [TEG] platelet mapping) and laboratorybased techniques (e.g.…”

Section: Pft and Genotyping In Pcimentioning

confidence: 99%

Platelet Function Testing and Genotyping for Tailoring Treatment in Complex PCI Patients

Moulias

Papageorgiou

Alexopoulos

2021

US Cardiology Review

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Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 receptor inhibitor, is considered the cornerstone of treatment in patients who have undergone percutaneous coronary intervention (PCI). Patients with complex PCI (C-PCI) constitute a special PCI subpopulation, characterized by increased ischemic risk. Identifying the optimal DAPT strategy is often challenging and remains controversial in this setting. In an attempt to balance ischemic and bleeding risks in C-PCI patients receiving DAPT, treatment individualization regarding potency and duration has evolved as a feasible approach. Platelet function testing and genotyping have been evaluated in several trials with conflicting and mostly neutral results. The aim of this review is to critically appreciate the role of these tools for antiplatelet treatment tailoring specifically in C-PCI patients. Because existing evidence is limited, dedicated future studies are warranted to elucidate the utility of platelet function testing and genotyping in C-PCI.

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De-Escalation of Treatment With Oral P2Y12 Receptor Inhibitors: Current Status and Perspectives

Cited by 5 publications

References 60 publications

Frequency and clinical outcomes of CYP2C19 genotype-guided escalation and de-escalation of antiplatelet therapy in a real-world clinical setting

Frequency and clinical outcomes of CYP2C19 genotype-guided escalation and de-escalation of antiplatelet therapy in a real-world clinical setting

Potent P2Y12 inhibitors versus clopidogrel to predict adherence to antiplatelet therapy after an acute coronary syndrome: insights from IDEAL-LDL

Platelet Function Testing and Genotyping for Tailoring Treatment in Complex PCI Patients

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