Introduction: Clopidogrel is the most frequently utilized P2Y12 inhibitor and is characterized by broad interindividual response variability resulting in impaired platelet inhibition and increased risk of thrombotic complications in a considerable number of patients. The potent P2Y12 inhibitors, prasugrel and ticagrelor, can overcome this limitation but at the expense of an increased risk of bleeding. Genetic variations of the cytochrome P450 (CYP) 2 C19 enzyme, a key determinant in clopidogrel metabolism, have been strongly associated with clopidogrel response profiles prompting investigations of genetic-guided selection of antiplatelet therapy. Areas covered: The present manuscript focuses on the rationale for the use of genetic testing to guide the selection of platelet P2Y12 inhibitors among patients undergoing percutaneous coronary intervention (PCI). Moreover, a comprehensive appraisal of the available evidence and practical recommendations is provided. Expert Commentary: Implementation of genetic testing as a strategy to guide the selection of therapy can result in escalation (i.e. switching to prasugrel or ticagrelor) or de-escalation (i.e. switching to clopidogrel) of P2Y12 inhibiting therapy. Most recent investigations support the clinical benefit of a genetic guided selection of antiplatelet therapy in patients undergo PCI. Integrating the results of genetic testing with clinical and procedural variables represents a promising strategy for a precision medicine approach for the selection of antiplatelet therapy among patients undergoing PCI.

Galli, M., Franchi, F., Rollini, F., Cavallari, L. H., Capodanno, D., Crea, F., Angiolillo, D. J., Genetic testing in patients undergoing percutaneous coronary intervention: rationale, evidence and practical recommendations, <<EXPERT REVIEW OF CLINICAL PHARMACOLOGY>>, 2021; 14 (8): 963-978. [doi:10.1080/17512433.2021.1927709] [http://hdl.handle.net/10807/204080]

Genetic testing in patients undergoing percutaneous coronary intervention: rationale, evidence and practical recommendations

Galli, Mattia;Franchi, Francesca;Crea, Filippo;
2021

Abstract

Introduction: Clopidogrel is the most frequently utilized P2Y12 inhibitor and is characterized by broad interindividual response variability resulting in impaired platelet inhibition and increased risk of thrombotic complications in a considerable number of patients. The potent P2Y12 inhibitors, prasugrel and ticagrelor, can overcome this limitation but at the expense of an increased risk of bleeding. Genetic variations of the cytochrome P450 (CYP) 2 C19 enzyme, a key determinant in clopidogrel metabolism, have been strongly associated with clopidogrel response profiles prompting investigations of genetic-guided selection of antiplatelet therapy. Areas covered: The present manuscript focuses on the rationale for the use of genetic testing to guide the selection of platelet P2Y12 inhibitors among patients undergoing percutaneous coronary intervention (PCI). Moreover, a comprehensive appraisal of the available evidence and practical recommendations is provided. Expert Commentary: Implementation of genetic testing as a strategy to guide the selection of therapy can result in escalation (i.e. switching to prasugrel or ticagrelor) or de-escalation (i.e. switching to clopidogrel) of P2Y12 inhibiting therapy. Most recent investigations support the clinical benefit of a genetic guided selection of antiplatelet therapy in patients undergo PCI. Integrating the results of genetic testing with clinical and procedural variables represents a promising strategy for a precision medicine approach for the selection of antiplatelet therapy among patients undergoing PCI.
2021
Inglese
Galli, M., Franchi, F., Rollini, F., Cavallari, L. H., Capodanno, D., Crea, F., Angiolillo, D. J., Genetic testing in patients undergoing percutaneous coronary intervention: rationale, evidence and practical recommendations, <<EXPERT REVIEW OF CLINICAL PHARMACOLOGY>>, 2021; 14 (8): 963-978. [doi:10.1080/17512433.2021.1927709] [http://hdl.handle.net/10807/204080]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/204080
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