Key result
Genotype and platelet function testing-guided selection of P2Y12 inhibitors identifies patients with high or low platelet reactivity to balance thrombotic and bleeding risks, though mainstream adoption remains limited.
Why the study?
Despite evolving data on genetic and platelet function testing for P2Y12 inhibitors, implementation of these testing modalities has not gained mainstream adoption across hospital systems.
Does genotype or platelet function-guided P2Y12 inhibitor therapy improve ischemic outcomes without increasing bleeding in patients with CAD/ACS undergoing PCI?
Does genotype or platelet function-guided P2Y12 inhibitor therapy improve ischemic outcomes without increasing bleeding in patients with CAD/ACS undergoing PCI?
This review highlights the evolving but mixed evidence for using genetic or platelet function testing to guide P2Y12 inhibitor selection in patients undergoing PCI.
May support personalized P2Y12 selection in PCI; leaves open outcome benefits and should not yet change practice.
The pharmacodynamics of the purinergic receptor type Y, subtype 12 (P2Y12) inhibitors has evolved. Our understanding of the metabolism of P2Y12 inhibitors has revealed polymorphisms that impact drug metabolism and antiplatelet efficacy, leading to genetic testing guided therapy. In addition, assays of platelet function and biochemistry have provided insight into our understanding of the efficacy of "antiplatelet" therapy, identifying patients with high or low platelet reactivity on P2Y12 therapy. Despite the data, the implementation of these testing modalities has not gained mainstream adoption across hospital systems. Given differences in potency between the three clinically available P2Y12 inhibitors, the balance between thrombotic and bleeding complications must be carefully considered, especially for the large proportion of patients at higher risk for bleeding. Here we review the current data for genetic and functional testing, risk assessment strategies, and guidelines for P2Y12 inhibitors guided therapy.
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Al‐Abcha et al. (2022) conducted a review in Coronary artery disease treated with percutaneous coronary intervention. Genotype-guided and platelet function testing-guided P2Y12 inhibitor therapy vs. Standard unguided therapy was evaluated. Genotype and platelet function testing-guided selection of P2Y12 inhibitors identifies patients with high or low platelet reactivity to balance thrombotic and bleeding risks, though mainstream adoption remains limited.
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