Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention

Dirk Sibbing (1) , Daniel Aradi (2) , Dimitrios Alexopoulos (3) , Jurriën ten Berg (4) , Deepak Bhatt (5) , Laurent Bonello (6) , Jean-Philippe Collet (7) , Thomas Cuisset (6) , Francesco Franchi (8) , Lisa Gross (1) , Paul Gurbel , Young-Hoon Jeong (9) , Roxana Mehran (10) , David Moliterno (11) , Franz-Josef Neumann (12) , Naveen Pereira (13) , Matthew Price (14) , Marc S Sabatine (15) , Derek Y.F. So (16) , Gregg Stone (17) , Robert Storey (18) , Udaya Tantry (19) , Dietmar Trenk (20) , Marco Valgimigli (20) , Ron Waksman (21) , Dominick Angiolillo (22)

1 LMU - Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München
2 Semmelweis University [Budapest]
3 University of Athens Medical School [Athens]
4 St. Antonius Hospital [Nieuwegein]
5 VA Boston Healthcare System
6 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
7 Institut de cardiologie [CHU Pitié-Salpêtrière]
8 UNF - University of North Florida [Jacksonville]
9 Gyeongsang National University
10 MSSM - Icahn School of Medicine at Mount Sinai [New York]
11 UK - University of Kentucky
12 University Hospital Freiburg
13 Mayo Clinic
14 Scripps Clinic [San Diego, CA, USA]
15 HMS - Harvard Medical School [Boston]
16 University of Ottawa [Ottawa]
17 Columbia University [New York]
18 University of Sheffield [Sheffield]
19 MSH - Mount Sinai Hospital [Toronto, Canada]
20 UNIBE - Universität Bern / University of Bern
21 Washington University School of Medicine in St. Louis
22 UF - University of Florida [Gainesville]

Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y(12) receptor inhibitor is the standard treatment for patients undergoing percutaneous coronary intervention. The availability of different P2Y(12) receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment regimens, which may include escalation or de-escalation of P2Y(12)-inhibiting therapy. Indeed, 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. long-term treatment), and patient risk for ischemic and bleeding complications. A tailored DAPT approach may be potentially guided by platelet function testing (PFT) or genetic testing. Although the routine use of PFT or genetic testing in percutaneous coronary intervention-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 expand on when to implement the selective use of such assays into decision making for personalized treatment approaches. Therefore, an international expert consensus group of key leaders from North America, Asia, and Europe with expertise in the field of antiplatelet treatment was convened. This document updates 2 prior consensus papers on this topic and summarizes the contemporary updated expert consensus recommendations for the selective use of PFT or genotyping in patients undergoing percutaneous coronary intervention. (c) 2019 by the American College of Cardiology Foundation.

Mots clés: genotyping; P2Y(12) receptor inhibitor; platelet function testing; thrombosis; GUIDED ANTIPLATELET THERAPY; CLOPIDOGREL-TREATED PATIENTS; OF-FUNCTION POLYMORPHISM; ELEVATION MYOCARDIAL-INFARCTION; PATIENTS SHOWING RESISTANCE; ASPIRIN AND/OR RESISTANCE; BYPASS GRAFT-SURGERY; CYP2C19 GENOTYPE; DUAL ANTIPLATELET; STENT THROMBOSIS

Domaines: Sciences du Vivant [q-bio]; Médecine humaine et pathologie; Cardiologie et système cardiovasculaire

Dirk Sibbing, Daniel Aradi, Dimitrios Alexopoulos, Jurriën ten Berg, Deepak Bhatt, et al.. Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention. JACC: Cardiovascular Interventions, 2019, 12 (16), pp.1521-1537. ⟨10.1016/j.jcin.2019.03.034⟩. ⟨hal-02898975⟩