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April 1, 2026Pharmacogenomics

Antiplatelet therapy in high-bleeding risk patients with acute coronary syndrome: pharmacogenomics in the era of precision medicine

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Key result

CYP2C19 pharmacogenomics with short DAPT or monotherapy improves safety and efficacy for HBR patients with ACS.

Why the study?

Managing HBR patients undergoing PCI for ACS remains challenging due to limited data on balancing ischemic prevention and bleeding avoidance.

Design

Literature review

Authors

NMNikolaos MichailidisMPMyria PallikarouVMVangelis G. Manolopoulos

Discussion

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Overview

May warrant CYP2C19 testing to guide short DAPT in HBR ACS; extends pharmacogenomic evidence to high-bleeding-risk PCI cohorts.

Key Points

  • To explore the management of antiplatelet therapy for high-bleeding risk patients with acute coronary syndrome undergoing PCI.
  • Literature search on PubMed/MEDLINE and Embase
  • Review of randomized trials and meta-analyses
  • Analysis of major guidelines on high-bleeding risk and antiplatelet strategies
  • Discussion of CYP2C19 pharmacogenomics in personalized therapy
  • Shortening dual antiplatelet therapy duration may reduce bleeding incidence
  • Preference for clopidogrel can maintain effective ischemic protection
  • Pharmacogenomic testing facilitates individualized treatment strategies

Structured PICO

P
Population
High-bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) for an acute coronary syndrome (ACS)
I
Intervention
Individualized antiplatelet therapy including CYP2C19 pharmacogenomic testing, short DAPT duration, and P2Y12 inhibitor monotherapy

Pharmacogenomic testing for CYP2C19 and individualized antiplatelet strategies like short DAPT or monotherapy may help balance ischemic and bleeding risks in HBR patients with ACS undergoing PCI.

Limitations

  • Data for HBR patients are limited
  • Understudied HBR patient population

Cite This Study

Michailidis et al. (2026) studied this question. Integrating CYP2C19 pharmacogenomics with short dual antiplatelet therapy or monotherapy improves safety and efficacy for high-bleeding risk patients with acute coronary syndrome.

synapsesocial.com/papers/69ccb6b416edfba7beb88715https://doi.org/10.1080/14622416.2026.2648609
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Navigating Ischemic and Bleeding Risks in High Bleeding Risk Patients Undergoing Coronary Intervention2026
  2. 2Improving on current guidelines for aspirin-free strategies after percutaneous coronary intervention and future perspectives2025
  3. 3Personalized Antithrombotic Therapy After Percutaneous Coronary Intervention: A Systematic Review of Risk‐Stratified Approaches2026
  4. 4Antiplatelet Therapy in Percutaneous Coronary Intervention Patients with Concurrent High Ischemic and Bleeding Risk2025 · 2 citations
  5. 5Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk2023 · 2 citations