Personalized antiplatelet therapy with P2Y12 receptor inhibitors: Benefits and pitfalls

Max Paul Winter, Marek Koziński, Jacek Kubica, D. Aradi, Jolanta M. Siller-Matula

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Antiplatelet therapy with P2Y12 receptor inhibitors has become the cornerstone of medical treatment in patients with acute coronary syndrome, after percutaneous coronary intervention and in secondary prevention of atherothrombotic events. Clopidogrel used to be the most broadly prescribed P2Y12 receptor inhibitor with undisputable benefits especially in combination with aspirin, but a considerable number of clopidogrel-treated patients experience adverse thrombotic events in whom insufficient P2Y12-inhibition and a consequential high on-treatment platelet reactivity is a common finding. This clinically relevant limitation of clopidogrel has driven the increased use of new antiplatelet agents. Prasugrel (a third generation thienopyridine) and ticagrelor (a cyclopentyl-triazolo-pyrimidine) feature more potent and predictable P2Y12-inhibition compared to clopidogrel, which translates into improved ischemic outcomes. However, excessive platelet inhibition and consequential low on-treatment platelet reactivity comes at the price of increased risk of major bleeding. The majority of randomized clinical trials failed to demonstrate improved clinical outcomes with platelet function testing and tailored antiplatelet therapy, but results of all recent trials of potent antiplatelets and prolonged antiplatelet durations point towards a need for individualized antiplatelet approach in order to decrease thrombotic events without increasing bleeding. This review focuses on potential strategies for personalizing antiplatelet treatment.

Original languageEnglish
Pages (from-to)259-280
Number of pages22
JournalPostepy w Kardiologii Interwencyjnej
Volume11
Issue number4
DOIs
Publication statusPublished - 2015

Fingerprint

clopidogrel
Blood Platelets
Therapeutics
Hemorrhage
Platelet Aggregation Inhibitors
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Secondary Prevention
Aspirin
Randomized Controlled Trials

Keywords

  • Acute coronary syndromes
  • Antiplatelet therapy
  • P2Y receptor inhibitors
  • Platelet reactivity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Personalized antiplatelet therapy with P2Y12 receptor inhibitors : Benefits and pitfalls. / Winter, Max Paul; Koziński, Marek; Kubica, Jacek; Aradi, D.; Siller-Matula, Jolanta M.

In: Postepy w Kardiologii Interwencyjnej, Vol. 11, No. 4, 2015, p. 259-280.

Research output: Contribution to journalArticle

Winter, Max Paul ; Koziński, Marek ; Kubica, Jacek ; Aradi, D. ; Siller-Matula, Jolanta M. / Personalized antiplatelet therapy with P2Y12 receptor inhibitors : Benefits and pitfalls. In: Postepy w Kardiologii Interwencyjnej. 2015 ; Vol. 11, No. 4. pp. 259-280.
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