Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention

Dirk Sibbing, Daniel Aradi, Dimitrios Alexopoulos, Jurrien ten Berg, Deepak L. Bhatt, Laurent Bonello, Jean Philippe Collet, Thomas Cuisset, Francesco Franchi, Lisa Gross, Paul Gurbel, Young Hoon Jeong, Roxana Mehran, David J. Moliterno, Franz Josef Neumann, Naveen L. Pereira, Matthew J. Price, Marc S. Sabatine, Derek Y.F. So, Gregg W. StoneRobert F. Storey, U. Tantry, Dietmar Trenk, M. Valgimigli, Ron Waksman, Dominick J. Angiolillo

Research output: Contribution to journalReview article

41 Scopus citations

Abstract

Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the standard treatment for patients undergoing percutaneous coronary intervention. The availability of different P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment regimens, which may include escalation or de-escalation of P2Y12-inhibiting therapy. Indeed, individualized and alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early- vs. long-term treatment), and patient risk for ischemic and bleeding complications. A tailored DAPT approach may be potentially guided by platelet function testing (PFT) or genetic testing. Although the routine use of PFT or genetic testing in percutaneous coronary intervention–treated patients is not recommended, recent data have led to an update in guideline recommendations that allow considering selective use of PFT for DAPT de-escalation. However, guidelines do not expand on when to implement the selective use of such assays into decision making for personalized treatment approaches. Therefore, an international expert consensus group of key leaders from North America, Asia, and Europe with expertise in the field of antiplatelet treatment was convened. This document updates 2 prior consensus papers on this topic and summarizes the contemporary updated expert consensus recommendations for the selective use of PFT or genotyping in patients undergoing percutaneous coronary intervention.

Original languageEnglish (US)
Pages (from-to)1521-1537
Number of pages17
JournalJACC: Cardiovascular Interventions
Volume12
Issue number16
DOIs
StatePublished - Aug 26 2019

Keywords

  • P2Y receptor inhibitor
  • genotyping
  • platelet function testing
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Sibbing, D., Aradi, D., Alexopoulos, D., ten Berg, J., Bhatt, D. L., Bonello, L., Collet, J. P., Cuisset, T., Franchi, F., Gross, L., Gurbel, P., Jeong, Y. H., Mehran, R., Moliterno, D. J., Neumann, F. J., Pereira, N. L., Price, M. J., Sabatine, M. S., So, D. Y. F., ... Angiolillo, D. J. (2019). Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention. JACC: Cardiovascular Interventions, 12(16), 1521-1537. https://doi.org/10.1016/j.jcin.2019.03.034