Abstract
Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the standard treatment for patients undergoing percutaneous coronary intervention. The availability of different P2Y12 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 P2Y12-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.
| Original language | English |
|---|---|
| Pages (from-to) | 1521-1537 |
| Number of pages | 17 |
| Journal | JACC: Cardiovascular Interventions |
| Volume | 12 |
| Issue number | 16 |
| DOIs | |
| State | Published - Aug 26 2019 |
Bibliographical note
Publisher Copyright:© 2019 American College of Cardiology Foundation
Funding
Dr. Alexopoulos has received personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, and Medtronic. Dr. Angiolillo has received payments as an individual for consulting fees or honoraria from Amgen, Aralez, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Daiichi Sankyo, Eli Lilly, Haemonetics, Janssen, Merck, PhaseBio, PLx Pharma, Pfizer, Sanofi, and The Medicines Company; has received payments as an individual for participation in review activities from CeloNova and St. Jude Medical; has received institutional payments for grants from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi Sankyo, Eisai, Eli Lilly, Gilead, Idorsia, Janssen, Matsutani Chemical Industry, Merck, Novartis, Osprey Medical, and Renal Guard Solutions; and has received funding from the Scott R. MacKenzie Foundation and the National Institutes of Health/National Center for Advancing Translational Sciences Clinical and Translational Science Award to the University of Florida (UL1 TR000064) and the National Institutes of Health/National Human Genome Research Institute (U01 HG007269), outside the submitted work. Dr. Aradi has received lecture fees from AstraZeneca. Dr. ten Berg has received advisory, consulting, and speaking fees from AstraZeneca, Eli Lilly, Daiichi Sankyo, The Medicines Company, Accumetrics, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Bayer, and Ferrer; and has received research grants from ZonMw and AstraZeneca. Dr. Bhatt is a member of the advisory boards of Cardax, PhaseBio, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is a member of the boards of directors of the Boston VA Research Institute, the Society of Cardiovascular Patient Care, and TobeSoft; is chair of the American Heart Association Quality Oversight Committee; is a member of data monitoring committees for the Baim Institute for Clinical Research (formerly the Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), the Cleveland Clinic, the Duke Clinical Research Institute, the Mayo Clinic, the Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), and the Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News,ACC.org; vice chair, ACC Accreditation Committee), the Baim Institute for Clinical Research (formerly the Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (editor-in-chief, Harvard Heart Letter), the Duke Clinical Research Institute (clinical trial steering committees), HMP Global (editor-in-chief, Journal of Invasive Cardiology), the Journal of the American College of Cardiology (guest editor, associate editor), the Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and U.S. national coleader, funded by Bayer), Slack Publications (chief medical editor, Cardiology Today's Intervention), the Society of Cardiovascular Patient Care (secretary/treasurer), WebMD (continuing medical education steering committees); is deputy editor of Clinical Cardiology; is chair of the NCDR-ACTION Registry Steering Committee; is chair of the VA CART Research and Publications Committee has received research funding from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Eli Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); is a site co-investigator for Biotronik, Boston Scientific, St. Jude Medical (now Abbott), and Svelte; is a trustee of the American College of Cardiology; and has conducted unfunded research for FlowCo, Merck, Novo Nordisk, PLx Pharma, and Takeda. Dr. Bonello has received research grants from AstraZeneca, Boston, Abbott, and Biosensors. Prof. Collet has received research grants from Bristol-Myers Squibb and Medtronic; and has received lecture fees from Bristol-Myers Squibb, Bayer, Daiichi Sankyo, AstraZeneca, and Medtronic. Dr. Cuisset has received consulting and lecture fees from AstraZeneca, Sanofi, and Terumo. Dr. Franchi received consulting fees or honoraria from AstraZeneca and Sanofi. Dr. Gurbel has received grants from the National Institutes of Health, Bayer, Medicure, Instrumentation Labs, Haemonetics, Amgen, Idorsia, Ionis, Janssen, and Merck; has received honoraria and payment for lectures and consultations, including service on Speakers Bureau, from Bayer, Janssen, Merck, UpToDate, and Medicure; and holds patents in the area of personalized antiplatelet therapy and interventional cardiology. Dr. Jeong has received honoraria for lectures from AstraZeneca, Sanofi, Daiichi Sankyo/Lilly, Haemonetics, Otsuka, Han-mi Pharmaceuticals, and Yuhan Pharmaceuticals; and has received research grants or support from AstraZeneca, the Korean Society of Interventional Cardiology, Han-mi Pharmaceuticals, Yuhan Daewoong Pharmaceuticals, Otsuka, and Haemonetics. Dr. Mehran has received institutional grant support from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol-Myers Squibb/Sanofi, CSL Behring, Eli Lilly/Daiichi Sankyo, Medtronic, Novartis, and OrbusNeich; is a consultant to Abbott Vascular, Boston Scientific, Cardiovascular Systems, Siemens Medical Solutions, Medscape, and Spectranetics; receives executive committee or advisory board funding from Janssen Pharmaceuticals, Osprey Medical, Bristol-Myers Squibb; has received data and safety monitoring board membership funding paid to the institution from Watermark Research Partners; and holds <1% equity with Claret Medical and Elixir Medical; Dr. Mehran's spouse is a consultant to The Medicines Company and Abiomed. Dr. Moliterno has received research grant funding from AstraZeneca. Dr. Pereira was funded by NIH/NHLBI grant U01HL128606. Dr. Sabatine has received institutional grant support and research grants from Amgen, AstraZeneca, Bayer, Quark Pharmaceuticals, Daiichi Sankyo, Eisai, GlaxoSmithKline, Intarcia, Janssen Research and Development, The Medicines Company, MedImmune, Merck, Novartis, Pfizer, Poxel, and Takeda; and has received personal fees for consulting from Amgen, AstraZeneca, Bristol-Myers Squibb, Anthos Therapeutics, DalCor, IFM Therapeutics, CVS Caremark, Dyrnamix, Esperion, Intarcia, Janssen Research and Development, The Medicines Company, MedImmune, Merck, and Novartis. Dr. Sibbing has received grants and personal fees from Roche Diagnostics and Daiichi Sankyo; and has received personal fees from Bayer, Pfizer, Sanofi, and Haemonetics during the conduct of the study. Dr. So has received unrestricted grant support (physician-initiated grant) from Eli Lilly Canada; is a member of the advisory board and has received honoraria from AstraZeneca Canada; is a member of the advisory board for Bayer Canada; has received unrestricted grant support (physician-initiated grant) from Spartan Biosciences; has received unrestricted grant support (physician-initiated grant) from Aggredyne; has received unrestricted grant support (physician-initiated grant) from Diapharma/Roche Diagnostics; and has received honoraria from Abbott Vascular, Canada. Dr. Storey has received institutional research grants and support from AstraZeneca and PlaqueTec; has received consultancy fees from Actelion, AstraZeneca, Avacta, Bayer, Bristol-Myers Squibb/Pfizer, Idorsia, Novartis, PlaqueTec, and Thromboserin; and has received honoraria from AstraZeneca and Bayer. Dr. Tantry has received honoraria and payment for lectures from UpToDate, AstraZeneca, and Medicure. Dr. Trenk has received advisory, consulting, and speaking fees from Amgen, AstraZeneca, Bayer, Berlin Chemie, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Pfizer, and Sanofi. Dr. Valgimigli has received personal fees from Abbott, AstraZeneca, Chiesi, Bayer, Daiichi Sankyo, Terumo, CID, and Amgen; has received grants from the Swiss National Foundation, Terumo, Medicure, Abbott, and Astra Zeneca, outside the submitted work. Dr. Waksman is a member of the advisory boards of Abbott Vascular, Amgen, Boston Scientific, Medtronic, Philips Volcano, Pi-Cardia, and Cardioset; is a consultant for Abbott Vascular, Amgen, Biosensors, Biotronik, Boston Scientific, Medtronic, Philips Volcano, Pi-Cardia, and Cardioset; has received grant support from Abbott Vascular, AstraZeneca, Biosensors, Biotronik, Boston Scientific, and Chiesi; is a member of the Speakers Bureau of AstraZeneca and Chiesi; is an investor in MedAlliance; is a consultant and Speakers Bureau member for AstraZeneca and Chiesi; and has received research grants from Astrazeneca and Chiesi. Dr. Stone has received personal fees from Claret, Ablative Solutions, Matrizyme, Miracor, Neovasc, V-wave, Shockwave, Valfix, TherOx, Reva, Vascular Dynamics, Robocath, HeartFlow, and Gore; and has received other from MedFocus family of funds, Ancora, Cagent, Qool Therapeutics, Aria, Caliber, SpectraWave, and Biostar family of funds, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. H. Vernon Anderson, MD, served as Guest Editor for this paper.
| Funders | Funder number |
|---|---|
| Astrazeneca and Chiesi | |
| Baim Institute for Clinical Research | |
| Biostar family of funds | |
| CeloNova | |
| Daiichi Sankyo Company, Limited | |
| Eli Lilly and Daiichi Sankyo | |
| Eli Lilly and Daiichi Sankyo | |
| Ferrer | |
| Haemonetics Inc. | |
| Harvard Clinical Research Institute | |
| MedFocus family of funds | |
| Population Health Research Institute | |
| Quark Pharmaceuticals Inc | |
| Slack Publications | |
| Society of Cardiovascular Patient Care | |
| Speakers Bureau of AstraZeneca | |
| TobeSoft | |
| U.S. national coleader | |
| VA CART | |
| National Institutes of Health (NIH) | |
| National Heart, Lung, and Blood Institute (NHLBI) | U01HL128606 |
| National Human Genome Research Institute | U01 HG007269 |
| Mayo Clinic Rochester | |
| Abbott Laboratories | |
| AMGen | |
| Bristol-Myers Squibb | |
| Eli Lilly and Company | |
| Pfizer | |
| AstraZeneca | |
| Bayer AG | |
| Novartis | |
| Medtronic | |
| Janssen Research and Development | |
| American College of Cardiology Foundation | |
| Gilead Sciences | |
| National Center for Advancing Translational Sciences (NCATS) | |
| St. Jude Medical Center | |
| Duke Clinical Research Institute | |
| Icahn School of Medicine at Mount Sinai | |
| Cleveland Clinic Foundation General Clinical Research Center of the Cleveland Clinic/Case Western Reserve University | |
| Chiesi Farmaceutici S.p.A. | |
| Florida AandM University and Florida State University | UL1 TR000064 |
| CSL Behring GmbH | |
| Boehringer-Ingelheim | |
| Takeda Pharmaceutical Company Limited | |
| Boston Scientific Corporation | |
| Boston VA Research Institute | |
| Janssen Pharmaceuticals | |
| Merck KGaA | |
| Abbott Vascular | |
| Amarin Corporation | |
| Medicines Company | |
| Osprey Medical | |
| Scott R. MacKenzie Foundation | |
| Regado Biosciences, Inc. | |
| Belvoir Media Group | |
| TherOx | |
| Eli Lilly Canada | |
| Sanofi-Aventis Deutschland | |
| Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung | |
| ZonMw Memorabel | |
| Centros de Investigación y Desarrollo, Universidad de Valparaíso | |
| Eisai | |
| Novo Nordisk A/S | |
| MedImmune | |
| Biotronik Incorporated | |
| Terumo Corporation | |
| OrbusNeich | |
| Daiichi Sankyo Europe |
Keywords
- P2Y receptor inhibitor
- genotyping
- platelet function testing
- thrombosis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine