DAPT, Our Genome and Clopidogrel
Peter C. Block, M.D., FACC
KEYWORDS
ACC Publications; Cardiology Interventions; Acute Coronary Syndrome; Adenosine; Alleles; Arteries; Aspirin; Blood Platelets; Confidence Intervals; Control Groups; Cytochrome P-450 Enzyme System; Dextrans; Follow-Up Studies; Genetic Testing; Genotype; Hemorrhage; Liver; Molecular Weight; Myocardial Infarction; Percutaneous Coronary Intervention; Platelet Aggregation; Platelet Function Tests; Polyethylene Glycols; Prodrugs; Prospective Studies; Registries; Research Personnel; Retrospective Studies; Risk Factors; Standard of Care; Stents; Stroke; Thrombosis; Ticlopidine; Warfarin
I bet few, if any, interventional cardiologists fail to prescribe dual antiplatelet therapy (DAPT) using a P2Y12 inhibitor plus aspirin after performing a PCI. After all, the ravages that balloons, stents and other devices incur on the fragile endothelial lining of arteries that result in immediate platelet deposition have been known since the early days of PCI.1
"Platelet function while on DAPT is highly variable within genetic groups — because CYP2C19 genotype and platelet reactivity are imperfect correlates of each other."
"TROPICAL ACS points out that an individualized strategy based on genetic testing and early de-escalation of antiplatelet treatment can be considered as an alternative approach in patients with ACS managed with PCI."
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