Individualized or Uniform De-Escalation Strategies for Antiplatelet Therapy in Acute Coronary Syndrome: A Review of Clinical Trials with Platelet Function Testing and Genetic Testing-Based Protocols.
Oumaima El Alaoui El AbdallaouiDániel TornyosRéka LukácsDóra SzabóAndrás KomócsiPublished in: International journal of molecular sciences (2023)
This comprehensive literature review assessed the effectiveness of precision medicine approaches in individualizing P2Y12 de-escalation strategies, such as platelet function testing guidance, genetic testing guidance, and uniform de-escalation, for acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Analyzing six trials with a total of 13,729 patients, the cumulative analyses demonstrated a significant reduction in major adverse cardiac events (MACE), net adverse clinical events (NACE), and major and minor bleeding events with P2Y12 de-escalation. Specifically, the analysis found a 24% reduction of MACE and a 22% reduction of adverse event risk (relative risk (RR) 0.76, 95% confidence interval (CI): 0.71-0.82, and RR: 0.78, 95% CI 0.67-0.92, respectively). Reductions in bleeding events were highest with uniform unguided de-escalation, followed by guided de-escalations, while ischemic event rates were similarly lower across all three strategies. Although the review highlights the potential of individualized P2Y12 de-escalation strategies to offer a safer alternative to the long-term potent P2Y12 inhibitor-based dual antiplatelet therapy, it also indicates that laboratory-guided precision medicine approaches may not yet offer the expected benefits, necessitating further research to optimize individualized strategies and evaluate the potential of precision medicine approaches in this context.
Keyphrases
- acute coronary syndrome
- antiplatelet therapy
- percutaneous coronary intervention
- open label
- st segment elevation myocardial infarction
- st elevation myocardial infarction
- coronary artery bypass grafting
- clinical trial
- acute myocardial infarction
- patients undergoing
- atrial fibrillation
- coronary artery disease
- ejection fraction
- randomized controlled trial
- coronary artery bypass
- systematic review
- end stage renal disease
- newly diagnosed
- case report
- blood brain barrier
- phase iii
- adverse drug
- patient reported
- risk assessment
- left ventricular
- anti inflammatory