Escalation and De-Escalation of Antiplatelet Therapy after Acute Coronary Syndrome or PCI: Available Evidence and Implications for Practice

Gragnano, Felice; Capolongo, Antonio; Terracciano, Fabrizia; Gargiulo, Giuseppe; Sio, Vincenzo De; Cesaro, Arturo; Moscarella, Elisabetta; Patti, Giuseppe; Porto, Italo; Esposito, Giovanni; Angiolillo, Dominick J.; Calabrò, Paolo

doi:10.3390/jcm11216246

Cited by 4 publications

(2 citation statements)

References 47 publications

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“…The genetic factors include CYP polymorphism and P2Y12 polymorphism. [ 65 ] The cellular factors include platelet turnover rate, up/downregulation of P2Y12 receptor, and up/downregulation of platelet via P2Y12 independent pathways. The clinical factors include age, body mass index (BMI), chronic kidney disease (CKD), DM, drug interactions, intestinal absorption, and compliance.…”

Section: Discussionmentioning

confidence: 99%

Clopidogrel resistance and its relevance: Current concepts

Pradhan,

Bhandari,

Vishwakarma

et al. 2024

Journal of Family Medicine and Primary Care

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Clopidogrel is the most widely used P2Y12 receptor inhibitor (P2Y12i) as a part of dual antiplatelet therapy along with aspirin. Clopidogrel is a pro-drug and is metabolized to its active metabolite by the hepatic enzyme cytochrome P4502C19 (CYP2C19). This active metabolite is responsible for the antiplatelet action of clopidogrel. Recent studies have demonstrated that single nucleotide polymorphisms in the CYP2C19 gene, including CYP2C19*2,*3,*4, and *5 alleles, result in reduced production of the active metabolite of clopidogrel, and hence reduced inhibition of platelet aggregation. This in turn enhances the incidence of stent thrombosis and recurrent cardiovascular (CV) events. We report a case of coronary stent thrombosis due to clopidogrel resistance proven by CYP2C19 genotyping. We then review the literature on clopidogrel resistance and its impact on CV outcomes. Subsequently, we discuss the methods of diagnosis of resistance, evidence from clinical trials for tailoring clopidogrel therapy, the role of potent P2Y12 inhibitors, the current guidelines, and future directions.

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Section: Discussionmentioning

confidence: 99%

Clopidogrel resistance and its relevance: Current concepts

Pradhan,

Bhandari,

Vishwakarma

et al. 2024

Journal of Family Medicine and Primary Care

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“…For ACS, percutaneous coronary intervention (PCI) has been formalized as an effective treatment [5,6]. Patients with ACS often have a combination of clinical risk factors, such as hypertension, cerebral infarction, diabetes mellitus, smoking, and so on.…”

Section: Introductionmentioning

confidence: 99%

The Value of the Gensini Score For Prognostic Assessment in Patients with Acute Coronary Syndrome--A Retrospective Cohort Study Based on Machine Learning Methods

Chen,

Jia,

Mou

et al. 2023

Preprint

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Background The Gensini score (GS) provides a good assessment of the degree of coronary plate loading. However, its clinical significance has been little explored. Methods In this retrospective cohort study, we implemented model development and performance comparison on database of The Fourth Affiliated Hospital of Zhejiang University School of Medicine (2019.1-2020.12). The patients were followed up for 2 years. Follow-up endpoint was the occurrence of MACCEs. We extracted clinical baseline data from each ACS patient within 24 hours of hospital admission and randomly divided the datasets into 70% for model training and 30% for model validation. Area under the curve (AUC) was used to compare the prediction performance of XGBoost, SGD and KNN. A decision tree model was constructed to predict the probability of MACCEs using a combination of weight features picked by XGBoost and clinical significance. Results A total of 361 ACS patients who met the study criteria were included in this study. It could be observed that the probability of a recurrent MACCEs within 2 years was 25.2%. XGboost had the best predictive efficacy (AUC:0.97). GS has high clinical significance. Then we used GS, Age and CK-MB to construct a decision tree model to predict the probability model of MACCEs reoccurring, and the final AUC value reached 0.771. Conclusions GS is a powerful indicator for assessing the prognosis of patients with ACS. The cut-off value of GS in the decision tree model provides a reference standard for grading the risk level of patients with ACS.

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Author’s Reply to Kow et al.: “Comparison of Clinical Outcomes between Ticagrelor and Clopidogrel in East-Asian Patients with Acute Coronary Syndrome: Large Cohort Study”

Fang,

Lee

2024

Am J Cardiovasc Drugs

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Escalation and De-Escalation of Antiplatelet Therapy after Acute Coronary Syndrome or PCI: Available Evidence and Implications for Practice

Cited by 4 publications

References 47 publications

Clopidogrel resistance and its relevance: Current concepts

Clopidogrel resistance and its relevance: Current concepts

The Value of the Gensini Score For Prognostic Assessment in Patients with Acute Coronary Syndrome--A Retrospective Cohort Study Based on Machine Learning Methods

Author’s Reply to Kow et al.: “Comparison of Clinical Outcomes between Ticagrelor and Clopidogrel in East-Asian Patients with Acute Coronary Syndrome: Large Cohort Study”

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