• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

Tailored antiplatelet therapy improves outcomes in patients undergoing percutaneous coronary intervention

byAlice WangandTeddy Guo
April 29, 2021
in Cardiology, Chronic Disease, Hematology
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. Guided selection of antiplatelet therapy reduced rates of major adverse cardiovascular event rates compared to standard therapy.

2. Guided selection strategy was beneficial for both escalation and de-escalation of standard therapy, balancing patient-dependent ischemic and bleeding risks. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: Patients who undergo percutaneous coronary intervention (PCI) are typically started on dual antiplatelet therapy consisting of aspirin and clopidogrel. However, patients can have persistently high platelet reactivity (HPR) on clopidogrel due to individual metabolic differences, which includes genetic polymorphisms of enzymes such as cytochrome P450 2C19 (CYP2C19). This systematic review and meta-analysis sought to aggregate randomized control trials and observational studies comparing outcomes in patients with acute or chronic coronary syndromes undergoing PCI, started on guided vs. standard antiplatelet therapies. Data from over 20,000 patients demonstrate that guided selection of antiplatelet therapies reduced risk of major adverse cardiovascular events including myocardial infarction, stent thrombosis, stroke, and minor bleeding compared to standard therapy. Additionally, both stepwise escalation and de-escalation of standard therapy, depending on clinical context, were associated with improved outcomes with regard to bleeding and ischemic events. According to study results, guided selection of antiplatelet therapy improves outcomes for patients undergoing PCI by accounting for individual genetic and risk profiles, especially when employed in a stepwise manner.

Click to read the study in The Lancet

Relevant Reading: Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention 

In-Depth [systematic review and meta-analysis]: After rigorous literature search and screening, 11 randomized control trials and 3 observational studies were included in this analysis, resulting in a total of 20 743 patients. Risk ratios and 95% CI were calculated for the primary outcome trial-defined major adverse cardiovascular events and primary safety outcome bleeding events; secondary outcomes including death, myocardial infarction, stroke, and stent thrombosis were assessed as well. A breadth of outcomes and risk ratios are reported in this study. Commonly used antiplatelet agents were clopidogrel, ticagrelor, and prasugrel at varying dosages. Major adverse cardiovascular events were reduced in guided antiplatelet selection compared to standard (RR 0.78, 95% CI [0.63–0.95], p=0.015). Risk of minor bleeding was reduced in with guided selection therapy, but no significant difference in overall bleeding was observed (p=0.069). Guided therapy improved all secondary outcomes when fixed-effect and random-effects models were applied. Both de-escalation and escalation strategies starting from standard therapy as a baseline favored guided therapy selection, with favorable risk ratios most notable in reducing major adverse cardiovascular events (RR 0.74, 95% CI [0.57-0.95]), stent thrombosis (RR 0.62, 95% CI [0.42-0.91]), and any bleed (RR 0.81, 95% CI [0.68-0.96]). The conclusions drawn by this review and meta-analysis are limited by heterogeneity among included studies and their patient cohorts, differences in interventional protocols, as well as altered medication choices. Despite these limitations, this study compiles a large volume of patient-outcomes regarding antiplatelet therapy selection in patients undergoing PCI, overall supporting guided selection of oral therapies to suit each patient’s genetic profile and risk factors.

RELATED REPORTS

Canadian Syncope Risk Score demonstrates international external validation

Improved mortality rates for myocardial infarction, stroke, and pulmonary embolism in patients receiving dialysis between 1998 to 2015

Ophthalmologic procedures are not associated with increased risk for acute myocardial infarction

Image: PD

©2020 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: acute myocardial infarctionantiplateletaspirinbleeding riskcardiovascular eventsclopidogreldual anti-plateletdual anti-platelet therapy (DAPT)guided therapymajor bleedingMajor Bleeding Eventsminor bleedingmyocardial infarction (MI)percutaneous coronary interventionpercutaneous coronary intervention (PCI)plateletPrasugrelstent thrombosisstrokestroke riskTicagrelor
Previous Post

Sotatercept decreased vascular resistance in pulmonary arterial hypertension

Next Post

Association of oral corticosteroid bursts with severe adverse events in children

RelatedReports

Epileptogenic foci may be lateralized using functional brain glutamate imaging
Cardiology

Canadian Syncope Risk Score demonstrates international external validation

May 13, 2022
Fish oil and aspirin did not reduce arteriovenous fistula failure: The FAVOURED trail
Cardiology

Improved mortality rates for myocardial infarction, stroke, and pulmonary embolism in patients receiving dialysis between 1998 to 2015

April 22, 2022
Nonpowder gun-related pediatric eye injuries on the rise
Cardiology

Ophthalmologic procedures are not associated with increased risk for acute myocardial infarction

April 22, 2022
Stroke expansion following intra-arterial therapy may explain worse outcomes
Cardiology

Reduced bleeding risk with asundexian compared to apixaban in patients with atrial fibrillation

April 19, 2022
Next Post
Isolated mild/moderate thrombocytopenia may not require intervention

Association of oral corticosteroid bursts with severe adverse events in children

#VisualAbstract GHSG HD14: Intensified chemotherapy regimen (BEACOPP+ABVD) improved progression-free survival without improving overall survival over long-term follow-up

#VisualAbstract GHSG HD14: Intensified chemotherapy regimen (BEACOPP+ABVD) improved progression-free survival without improving overall survival over long-term follow-up

Quick Take: Risk of rhabdomyolysis with donepezil compared with rivastigmine or galantamine

Non-drug interventions highly efficacious at reducing depressive symptoms in people with dementia

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

Get 2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Alzheimer disease in individuals with Down syndrome has similar variability in age of onset and mortality rate as autosomal dominant forms
  • #VisualAbstract: Ruxolitinib shows long-term safety and efficacy in inadequately controlled polycythaemia vera without splenomegaly
  • Wellness Check: Sleep
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.