Abstract
In the field of antithrombotics, precision medicine is of particular interest, as it may lower the incidence of potentially life-threatening side effects. Indeed, antiplatelet drugs such as P2Y12 inhibitors are one of the most common causes of emergency admissions for drug-related adverse events. The last ten years have seen a continuous debate on whether platelet function tests (PFTs) should be used to tailor antiplatelet drugs to cardiovascular patients. Large-scale randomized studies investigating the escalation of antiplatelet therapies according to the results of PFTs were mostly negative. Potent P2Y12 inhibitors are recommended as a first-line treatment in acute coronary syndrome patients, bringing the bleeding risk at the forefront. De-escalation from prasugrel or ticagrelor to clopidogrel is now considered, with or without the use of a PFT. This review covers recent advances in escalation and de-escalation strategies based on PFTs in various clinical settings. It also describes the main features of the most popular platelet function tests as well as the potential added value of genetic testing. Finally, we detail practical suggestions on how PFTs could be used in clinical practice.
Highlights
Precision medicine has been gaining ground in recent years thanks to European [1] and American [2] initiatives; it refers to a medical model using the characterization of an individual’s phenotype and/or genotype to tailor a therapeutic strategy [1,2,3]
It seems that the level of baseline cardiovascular risk is important for the clinical relevance of high platelet reactivity (HPR) in patients treated with aspirin [52], a concept that has been investigated in depth among patients treated with clopidogrel
Regarding P2Y12 inhibitors, and as mentioned above, low on-treatment platelet reactivity (LPR) may be quite frequent with next-generation drugs prasugrel and ticagrelor, but the association with bleeding events has been studied more among patients treated with clopidogrel
Summary
Precision (or personalized) medicine has been gaining ground in recent years thanks to European [1] and American [2] initiatives; it refers to a medical model using the characterization of an individual’s phenotype and/or genotype to tailor a therapeutic strategy [1,2,3]. Data from major trials and registries have shown that approximately 9%–10% of patients receiving DAPT experienced a thrombotic event within one year, whereas bleeding events occurred in about 2% of patients [3,7,8] This suggests that individualized antiplatelet regimens, tailoring both DAPT potency as well as duration, might be beneficial in terms of net clinical benefit (i.e., the combination of ischemic and bleeding events). Several scores have been developed to identify patients at risk of bleeding or recurrent thrombotic events and who would benefit from a personalized approach to anti-P2Y12 selection and/or duration of DAPT.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
