Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention

Sibbing, Dirk; Aradi, Dániel; Alexopoulos, Dimitrios; Berg, Jurriën Ten; Bhatt, Deepak L.; Bonello, Laurent; Collet, Jean‐Philippe; Cuisset, Thomas; Franchi, Francesco; Groß, Lisa; Gurbel, Paul A.; Jeong, Young‐Hoon; Mehran, Roxana; Moliterno, David J.; Neumann, Franz‐Josef; Pereira, Naveen L.; Price, Matthew J.; Sabatine, Marc S.; So, Derek; Stone, Gregg W.; Storey, Robert F.; Tantry, Udaya S.; Trenk, Dietmar; Valgimigli, Marco; Waksman, Ron; Angiolillo, Dominick J.

doi:10.1016/j.jcin.2019.03.034

Cited by 442 publications

(417 citation statements)

References 95 publications

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“…e 2018 European guidelines on myocardial revascularization now recommend considering a PFT-guided DAPT deescalation strategy as an alternative DAPT strategy, particularly in patients with ACS in whom 12 months of potent antiplatelet therapy may not be appropriate [23]. Furthermore, a recent consensus statement supports PFTor genotype-guided deescalation, although these experts stated that, in patients undergoing PCI, PFT-guided deescalation may only be considered in specific clinical scenarios [39].…”

Section: Platelet Function Testing Platelet Function Testing (Pft)mentioning

confidence: 99%

The Role of Clopidogrel in 2020: A Reappraisal

Patti

Micieli

Cimminiello

et al. 2020

Cardiovascular Therapeutics

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Antiplatelet therapy is the mainstay of treatment and secondary prevention of cardiovascular disease (CVD), including acute coronary syndrome (ACS), transient ischemic attack (TIA) or minor stroke, and peripheral artery disease (PAD). The P2Y12 inhibitors, of which clopidogrel was the first, play an integral role in antiplatelet therapy and therefore in the treatment and secondary prevention of CVD. This review discusses the available evidence concerning antiplatelet therapy in patients with CVD, with a focus on the role of clopidogrel. In combination with aspirin, clopidogrel is often used as part of dual antiplatelet therapy (DAPT) for the secondary prevention of ACS. Although newer, more potent P2Y12 inhibitors (prasugrel and ticagrelor) show a greater reduction in ischemic risk compared with clopidogrel in randomized trials of ACS patients, these newer P2Y12 inhibitors are often associated with an increased risk of bleeding. Deescalation of DAPT by switching from prasugrel or ticagrelor to clopidogrel may be required in some patients with ACS. Furthermore, real-world studies of ACS patients have not confirmed the benefits of the newer P2Y12 inhibitors over clopidogrel. In patients with very high-risk TIA or stroke, short-term DAPT with clopidogrel plus aspirin for 21–28 days, followed by clopidogrel monotherapy for up to 90 days, is recommended. Clopidogrel monotherapy may also be used in patients with symptomatic PAD. In conclusion, there is strong evidence supporting the use of clopidogrel antiplatelet therapy in several clinical settings, which emphasizes the importance of this medication in clinical practice.

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Section: Platelet Function Testing Platelet Function Testing (Pft)mentioning

confidence: 99%

The Role of Clopidogrel in 2020: A Reappraisal

Patti

Micieli

Cimminiello

et al. 2020

Cardiovascular Therapeutics

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“…105 However, as of today, no study has clearly revealed the benefit of stopping DAPT based on the results from platelet aggregation test. 106 Times have shifted to the era of a more individualized approach. Standard duration for DAPT is 6-12 months for ACS patients with high thrombotic risk; however, in cases of shortening DAPT to 1-3 months taking into considerationbleeding risk, monotherapy with P2Y12 receptor antagonist might be an effective treatment option.…”

Section: ▋ 134 Other Approachesmentioning

confidence: 99%

JCS 2020 Guideline Focused Update on Antithrombotic Therapy in Patients With Coronary Artery Disease

Nakamura

Kimura

et al. 2020

Circ J

244

199

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“…5,6 Thus, individualized antiplatelet therapy based on platelet function monitoring is recommended. 7 However, some randomized clinical trials using the VerifyNow system have been unable to show the clinical superiority of monitoring reported as P2Y12 reaction units (PRU). 8-11 A possible reason is that the PRU reflects platelet reactivity through P2Y12 receptors, but does not indicate total platelet-derived thrombogenicity because other pathways, such as thrombin receptors and thromboxane A2 receptors, also amplify platelet activation.…”

Section: T-tasmentioning

confidence: 99%

Platelet-Derived Thrombogenicity Measured by Total Thrombus-Formation Analysis System in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Kikuchi

Tsukahara

Ichikawa

et al. 2020

Circ J

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have been developed for more effective inhibition of P2Y12 receptors. Prompt and potent antiplatelet effects are required during PPCI in patients with STEMI.Monitoring platelet function enables determination of platelet function in individual patients. The VerifyNow system (Accumetrics, San Diego, CA, USA) is a user-friendly point-of-care platelet function test system that produces results rapidly using a simple method. High on-treatment P rimary percutaneous coronary intervention (PPCI) is the gold standard strategy for ST-elevation myocardial infarction (STEMI). 1,2 Adjunct antithrombotic therapy, such as dual antiplatelet therapy (DAPT) with aspirin and P2Y12 receptor inhibitors, and intravenous anticoagulant drugs are the cornerstones of pharmacological treatment in patients with STEMI undergoing PPCI and serve to support reperfusion and optimize clinical outcomes.Background: Prompt and potent antiplatelet effects are important aspects of management of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). We evaluated the association between plateletderived thrombogenicity during PPCI and enzymatic infarct size in STEMI patients. Methods and Results:Platelet-derived thrombogenicity was assessed in 127 STEMI patients undergoing PPCI by: (1) the area under the flow-pressure curve for the PL-chip (PL18-AUC10) using the total thrombus-formation analysis system (T-TAS); and (2) P2Y12 reaction units (PRU) using the VerifyNow system. Patients were divided into 2 groups (High and Low) based on median PL18-AUC10 during PPCI. PRU levels during PPCI were suboptimal in both the High and Low PL18-AUC10 groups (median [interquartile range] 266 [231-311] vs. 272 [217-317], respectively; P=0.95). The percentage of final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was lower in the High PL18-AUC10 group (75% vs. 90%; P=0.021), whereas corrected TIMI frame count (31.3±2.5 vs. 21.0±2.6; P=0.005) and the incidence of slow-flow/no-reflow phenomenon (31% vs. 11%, P=0.0055) were higher. The area under the curve for creatine kinase (AUCCK) was greater in the High PL18-AUC10 group (95,231±7,275 IU/L h vs. 62,239±7,333 IU/L h; P=0.0018). Multivariate regression analysis identified high PL18-AUC10 during PPCI (β=0.29, P=0.0006) and poor initial TIMI flow (β=0.37, P<0.0001) as independent determinants of AUCCK. Conclusions:T-TAS-based high platelet-derived thrombogenicity during PPCI was associated with enzymatic infarct size in patients with STEMI.

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Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention

Cited by 442 publications

References 95 publications

The Role of Clopidogrel in 2020: A Reappraisal

The Role of Clopidogrel in 2020: A Reappraisal

JCS 2020 Guideline Focused Update on Antithrombotic Therapy in Patients With Coronary Artery Disease

Platelet-Derived Thrombogenicity Measured by Total Thrombus-Formation Analysis System in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

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