Personalizing Antiplatelet Therapy

Paul A. Gurbel, Young Hoon Jeong, Udaya S. Tantry

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Currently, the evidence indicates that high platelet reactivity (HPR) and CYP2C19 LoF carriage are associated with poorer clinical outcomes in high-risk clopidogrel-treated patients who have undergone percutaneous coronary intervention (PCI). Therefore, a reasonable strategy is to assess platelet function and genetic testing in high-risk clopidogrel-treated patients and use more potent P2Y12 receptor therapy selectively in the patient with HPR. Platelet function testing may have a role to monitor (i) efficacy when clopidogrel is the chosen therapy and (ii) safety of long-term use of new more potent drugs especially in low-risk patients and patients with high bleeding risk. However, recent prospective, randomized trials have failed to demonstrate that personalized antiplatelet therapy based on platelet function is effective in reducing ischemic event occurrences. Thus, at this time we must rely on the guidelines and the existing observational data while keeping fully in mind the role that platelet physiology plays in catastrophic event occurrence in the stented patient.

Original languageEnglish (US)
Title of host publicationAntiplatelet Therapy in Cardiovascular Disease
PublisherWiley-Blackwell
Pages267-276
Number of pages10
ISBN (Electronic)9781118493984
ISBN (Print)9781118275757
DOIs
StatePublished - Jun 3 2014

Keywords

  • Clopidogrel
  • P2Y12 receptor
  • Percutaneous coronary interventions
  • Personalized antiplatelet therapy
  • Platelet function testing
  • Prasugrel
  • Single nucleotide polymorphisms
  • Ticagrelor

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Gurbel, P. A., Jeong, Y. H., & Tantry, U. S. (2014). Personalizing Antiplatelet Therapy. In Antiplatelet Therapy in Cardiovascular Disease (pp. 267-276). Wiley-Blackwell. https://doi.org/10.1002/9781118493984.ch32