The following are key perspectives from this review of the updated expert consensus statement on platelet function and genetic testing for guiding P2Y₁₂ receptor inhibitor treatment in percutaneous coronary intervention (PCI):

1. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ receptor inhibitor is the standard treatment for patients undergoing PCI.
2. The availability of different P2Y₁₂ receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has allowed clinicians to contemplate individualized treatment regimens, which may include escalation or de-escalation of P2Y₁₂-inhibiting therapy.
3. 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. chronic treatment), and patient risk for ischemic and bleeding complications. A tailored DAPT approach may be potentially guided by platelet function (PFT) or genetic testing.
4. While the routine use of PFT or genetic testing in PCI-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 address when to implement the selective use of such assays into decision making for personalized treatment approaches.
5. An international expert consensus group of key leaders from North America, Asia, and Europe with expertise in the field of antiplatelet treatment was convened to address use of such assays into decision making for individualized treatment.
6. The expert consensus group suggests that point-of-care assays are preferred over laboratory-based PFT assays and selection of assays should depend on the local site experience and availability.
7. Clinically validated and standardized assays should be used, and physicians should apply standardized definitions and cut-off values to determine a status of high (HPR) or low platelet reactivity (LPR).
8. PFT may be considered to guide decisions on timing of cardiac or noncardiac surgery and to reduce waiting time to surgery.
9. PFT to escalate treatment (switch to potent antiplatelet drugs) in patients with HPR on clopidogrel is not recommended on a routine basis but may be considered in specific clinical scenarios in patients with increased thrombotic risk.
10. Similarly, PFT to screen for HPR to determine the drug that would remain when DAPT cessation is desired (e.g., triple treatment where one antiplatelet agent is planned to be omitted) is not recommended on a routine basis, but may be considered in specific clinical scenarios.
11. Finally, for the individual patient, multiple factors, including thrombotic and bleeding risk as well as socioeconomic considerations, may play a role in the choice of P2Y₁₂ inhibitor therapy.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Coronary Artery Disease

Keywords: Acute Coronary Syndrome, Adenosine, Aspirin, Blood Platelets, Cardiac Surgical Procedures, Coronary Artery Disease, General Surgery, Genetic Testing, Genotyping Techniques, Hemorrhage, Myocardial Ischemia, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Platelet Function Tests, Secondary Prevention, Ticlopidine, Thrombosis

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