Key result
Platelet function guided therapy in patients with acute coronary syndrome treated with stenting is associated with similar ischemic risk but reduced bleeding risk.
Why the study?
High platelet reactivity during clopidogrel therapy predicts ischemic events after drug-eluting stent implantation, but uniform potent P2Y12 inhibitor use increases bleeding risk, necessitating assessment of platelet function testing to guide therapy.
Does platelet function testing-guided de-escalation of P2Y12 inhibitor therapy reduce bleeding without increasing ischemic events in patients with CAD treated with DES?
Does platelet function testing-guided de-escalation of P2Y12 inhibitor therapy reduce bleeding without increasing ischemic events in patients with CAD treated with DES?
Platelet function-guided de-escalation of P2Y12 inhibitor therapy in DES patients can reduce bleeding risk without compromising ischemic protection.
May support platelet function-guided P2Y12 de-escalation to reduce bleeding in stented ACS; leaves open need for randomized confirmation.
Introduction: Platelets play a pivotal role in the occurrence of recurrent ischemic events in coronary artery disease patients who are treated with drug-eluting stents and are on dual antiplatelet therapy (DAPT).Areas covered: High platelet reactivity (HPR) to adenosine diphosphate during clopidogrel therapy is a strong predictor of post-stenting ischemic event occurrences. However, uniform use of potent P2Y12 receptors blockers to overcome HPR is associated with elevated bleeding risk. Selective de-escalation of P2Y12 receptor blocker therapy based on PFT in patients with acute coronary syndrome treated with stenting has been shown to be associated with a similar risk of ischemic event occurrence but with a reduced risk of bleeding. This review aims to discuss the role of PFT in guiding DAPT in patients treated with DES. We searched electronic databases from January 2000 to December 2019 for literatures evaluating the role of platelet function assessment after drug eluting stents.Expert opinion: Platelet function guided therapy improves patient outcomes by lessening bleeding and limiting the overuse of highly potent P2Y12 inhibitors. Interest in this area of de-escalation of therapy will likely grow as the consequences of bleeding are better recognized and the cost of healthcare gains greater focus.
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Tantry et al. (2020) conducted a review in Coronary artery disease treated with drug-eluting stents on dual antiplatelet therapy. Platelet function testing (PFT) guided therapy vs. Uniform use of potent P2Y12 receptor blockers was evaluated. Platelet function guided therapy in patients with acute coronary syndrome treated with stenting is associated with similar ischemic risk but reduced bleeding risk.
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