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

2021 ◽  
Vol 15 ◽  
Author(s):  
Athanasios Moulias ◽  
Angeliki Papageorgiou ◽  
Dimitrios Alexopoulos
Keyword(s):  
Platelet Function ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Antiplatelet Treatment ◽  
Platelet Function Testing ◽  
Future Studies ◽  
Percutaneous Coronary ◽  
Treatment Individualization ◽  
Function Testing

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.

scholarly journals Expert position paper on the role of platelet function testing in patients undergoing percutaneous coronary intervention

2013 ◽  
Vol 35 (4) ◽  
pp. 209-215 ◽  
Author(s):  
Dániel Aradi ◽  
Robert F. Storey ◽  
András Komócsi ◽  
Dietmar Trenk ◽  
Dietrich Gulba ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Platelet Function ◽  
Coronary Intervention ◽  
Position Paper ◽  
Platelet Function Testing ◽  
Percutaneous Coronary ◽  
Function Testing

P1931Effect of de-escalated switching dual antiplatelet therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: real-world data from a nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C.-Y Hsu ◽  
J.-S Yeh ◽  
C.-Y Huang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Function Testing

Abstract Background Recently, both unguided (platelet function testing independent) and guided (platelet function testing dependent) DAPT de-escalation strategies have been investigated in different clinical studies but the data is still limited and conflicting. The aim of this study was to examine the effect of switching dual antiplatelet therapy (DAPT) on the major vascular risk after acute myocardial infarction (AMI) in patients undergoing percutaneous coronary intervention (PCI) by using Taiwan National Health Insurance Research Database. Methods In total, 1,903 and 4,059 patients defined as switched to aspirin and clopidogrel (switched DAPT) and continuation of aspirin and ticagrelor (unswitched DAPT) cohort, respectively who had received PCI during AMI hospitalization, on aspirin and ticagrelor initially and without occurring adverse events at 3 months were evaluated between 2013 and 2015. An inverse probability treatment of weighted approach was adopted to balance the baseline differences between two groups and Cox proportional hazard regression and competing risk regression were used to evaluated the effect of switching DAPT on death, AMI readmission, major bleeding and non-major clinically relevant bleeding. Results The incidence rates (per 100 person-year) of death and AMI readmission were 3.97 (95% confidence interval [CI] = 3.19–4.84) and 3.84 (95% CI = 3.09–4.73) in switched cohort and 1.83 (95% CI = 1.47–2.24) and 2.23 (95% CI = 1.82–2.68) in unswitched cohort, respectively. After adjustment for patients' clinical variables, switched cohort had higher risk of death (adjusted hazard ratio = 2.18, 95% CI = 1.62–2.93, P<0.001), and AMI readmission (adjusted sub-distribution ratio = 1.72, 95% CI = 1.27–2.34, P<0.001) compared to these in unswitched cohort; however, there was no difference in the risk of bleeding. Subgroup analysis showed a similar findings in many specific groups, except the patients who were younger age and had lower comorbidity score. Conclusion Switching DAPT might increase the risk of death and AMI readmission among patients with AMI undergoing PCI.

scholarly journals Platelet testing in flow diversion: a review of the evidence

2017 ◽  
Vol 42 (6) ◽  
pp. E5 ◽  
Author(s):  
L. Ian Taylor ◽  
James C. Dickerson ◽  
Robert J. Dambrino ◽  
M. Yashar S. Kalani ◽  
Philipp Taussky ◽  
...  
Keyword(s):  
Platelet Function ◽  
Dual Antiplatelet Therapy ◽  
Interventional Cardiology ◽  
Platelet Inhibition ◽  
Flow Diversion ◽  
Level Of Evidence ◽  
Platelet Function Testing ◽  
Rigorous Testing ◽  
Percutaneous Coronary ◽  
Function Testing

OBJECTIVEAlthough the use of dual antiplatelet therapy with flow diversion is recommended and commonplace, the testing of platelet inhibition is more controversial.METHODSThe authors reviewed the medical literature to establish and describe the physiology of platelet adhesion, the pharmacology of antiplatelet medications, and the mechanisms of the available platelet function tests. Additionally, they present a review of the pertinent neurointerventional and interventional cardiology literature.RESULTSCompeting reports in the neurointerventional literature argue for and against the use of routine platelet function testing, with adjustments to the dosage or medications based on the results. The interventional cardiology literature has also wrestled with this dilemma after percutaneous coronary interventions, with conflicting reports of the benefits of platelet function testing.CONCLUSIONSDespite its prevalence, the benefits of platelet function testing prior to flow diversion are unproven. This practice will likely remain controversial until the level of evidence improves through more rigorous testing and reporting.

Platelet function testing in acute cardiac care – is there a role for prediction or prevention of stent thrombosis and bleeding?

2015 ◽  
Vol 113 (02) ◽  
pp. 221-230 ◽  
Author(s):  
Jean-Philippe Collet ◽  
Johannes Mair ◽  
Mario Plebani ◽  
Béla Merkely ◽  
Allan S. Jaffe ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Platelet Function ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Current Evidence ◽  
Platelet Function Testing ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
European Society Of Cardiology ◽  
Function Testing

SummaryThe role of platelet function testing in acute coronary syndrome patients undergoing percutaneous coronary intervention remains controversial despite the fact that high platelet reactivity is an independent predictor of stent thrombosis and emerging evidence suggests also a link between low platelet reactivity and bleeding. In this expert opinion paper, the Study Group on Biomarkers in Cardiology of the Acute Cardiovascular Care Association and the Working Group on Thrombosis of the European Society of Cardiology aim to provide an overview of current evidence in this area and recommendations for practicing clinicians.

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