The Role of Platelet Reactivity and Genotype Testing in the Prevention of Atherothrombotic Cardiovascular Events Remains Unproven

Krishna, Vamsi; Diamond, George A.; Kaul, Sanjay

doi:10.1161/circulationaha.111.075242

Cited by 52 publications

(28 citation statements)

References 78 publications

(105 reference statements)

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“…8 Through biotransformation, R-130964 irreversibly inhibits platelet aggregation. Although numerous epigenetic factors influence generation of the active metabolite and platelet-reactivity phenotype, [14][15][16] variation in the cytochrome P450 (CYP) allele, especially CYP2C19, has been shown to have the greatest influence. 8 The clinical importance of these factors has been the subject of much research and debate.…”

Section: Current P2y 12 Inhibitorsmentioning

confidence: 99%

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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| Guideline recommendations on the use of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention (PCI) have been formulated by both the ACC/AHA and the ESC. These recommendations are based primarily on large, phase III, randomized, controlled trials of the P2Y 12 inhibitors clopidogrel, prasugrel, and ticagrelor. However, few East Asian patients have been included in the trials to assess the use of these agents, particularly the newer agents prasugrel and ticagrelor. Additionally, an increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with white patients, and that a different 'therapeutic window' of on-treatment platelet reactivity might be appropriate in East Asian patients. Furthermore, a phenomenon referred to as the 'East Asian paradox' has been described, in which East Asian patients have a similar or even a lower rate of ischaemic events after PCI compared with white patients, despite a higher level of platelet reactivity during DAPT. Recognizing these concerns, the World Heart Federation has undertaken this evidence-based review and produced this expert consensus statement to determine the antiplatelet treatment strategies that are most appropriate for East Asian patients.

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Section: Current P2y 12 Inhibitorsmentioning

confidence: 99%

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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“…60,69 This methodological background helps explain the aspirin "resistance" phenomenon, usually defined as lower-than-expected response to aspirin in heterogeneous studies, without an objective assessment of compliance. 70 Not surprisingly, the incidence of resistance ranges from 1% Figure 3. Recovery of serum TXB 2 after aspirin withdrawal in healthy subjects.…”

mentioning

confidence: 99%

“…70 The International Society on Thrombosis and Haemostasis defined this phenomenon as "variability in laboratory test response," rather than "resistance" to aspirin and recommended against monitoring aspirin response by standard aggregation. 71 Aspirin "resistance" has been considered in ET.…”

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confidence: 99%

Platelet activation and inhibition in polycythemia vera and essential thrombocythemia

Patrono

Rocca²,

Stefano

2013

Blood

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Persistently enhanced platelet activation has been characterized in polycythemia vera (PV) and essential thrombocythemia (ET) and shown to contribute to a higher risk of both arterial and venous thrombotic complications. The incidence of major bleeding complications is also somewhat higher in PV and ET than in the general population. Although its efficacy and safety was assessed in just 1 relatively small trial in PV, low-dose aspirin is currently recommended in practically all PV and ET patients. Although for most patients with a thrombosis history the benefit/risk profile of antiplatelet therapy is likely to be favorable, in those with no such history this balance will depend critically on the level of thrombotic and hemorrhagic risks of the individual patient. Recent evidence for a chemopreventive effect of low-dose aspirin may tilt the balance of benefits and harm in favor of using aspirin more broadly, but the potential for additional benefits needs regulatory scrutiny and novel treatment guidelines. A clear pharmacodynamic rationale and analytical tools are available for a personalized approach to antiplatelet therapy in ET, and an improved regimen of low-dose aspirin therapy should be tested in a properly sized randomized trial.

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“…25---27 The multifactorial nature of ST makes it difficult to predict and neither genotyping for reduced-function cytochrome P2C19 nor platelet function testing currently have a definite role. 28 Although new anticoagulant and antiplatelet therapies have the potential to influence future clinical decisions regarding the duration of DAPT, the current approved therapies should not be discontinued ahead of the recommendations in the guidelines. The era of personalized antiplatelet therapy is therefore eagerly awaited.…”

Section: Discussionmentioning

confidence: 99%

Triple, simultaneous, very late coronary stent thrombosis

Vieira

Luz

Anjo

et al. 2013

Revista Portuguesa de Cardiologia

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Coronary artery stent thrombosis is an uncommon but potentially catastrophic complication. The risk of very late stent thrombosis (VLST) raises important safety issues regarding the first generation of drug-eluting stents (DES). Although several complex mechanisms for VLST have been suggested and various predictors have been described, its pathophysiology is not completely understood and it is not known whether longer-term dual antiplatelet therapy reduces the risk. We present a rare case of simultaneous very late DES thrombosis in the three vascular territories, following discontinuation of antiplatelet therapy seven years after stent placement, presenting as cardiogenic shock. © 2012 Sociedade Portuguesa de Cardiologia Published by Elsevier España, S.L. All rights reserved. PALAVRAS-CHAVETrombose muito tardia de stent; Stents revestidos Trombose tripla, simultânea, muito tardia de stents coronários Resumo A trombose de stent coronário é uma complicação rara mas potencialmente catastrófica. O risco de trombose muito tardia de stent (TMTS) tem levantado questões importantes sobre a segurança do uso de stents revestidos com fármacos (SRF) de primeira geração. Embora sejam vários e complexos os mecanismos da TMTS e vários os preditores que têm sido descritos, a sua fisiopatologia ainda não está totalmente esclarecida e desconhece-se se o prolongar da terapêutica antiagregante dupla reduz esse risco. Descrevemos um caso raro de trombose muito tardia de SRF ocorrendo em simultâneo nos três territórios vasculares, após interrupção da terapêutica antiagregante, sete anos após implantação dos stents, apresentando-se como choque cardiogénico. © 2012 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L. Todos os direitos reservados. * Corresponding author. E-mail address: zemiguelvieira@gmail.com (M.S. Vieira). Case reportWe present the case of a 49-year-old man with a past history of non-Q wave myocardial infarction (MI) seven years

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The Role of Platelet Reactivity and Genotype Testing in the Prevention of Atherothrombotic Cardiovascular Events Remains Unproven

Cited by 52 publications

References 78 publications

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

Platelet activation and inhibition in polycythemia vera and essential thrombocythemia

Triple, simultaneous, very late coronary stent thrombosis

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