Individualized antiplatelet therapy

Summary

Safeguarding of antiplatelet drug efficacy represents a cornerstone for the optimal treatment of patients with symptomatic coronary artery disease requiring coronary interventions. This means a challenge to modern cardiology since there has been cumulative evidence, that response to common oral anti -platelet therapy is a highly variable phenomenon underlying various mechanisms. It is known, that particular risk groups exhibit a high residual platelet aggregability (RPA) despite conventional antiplatelet therapy. Additionally, a relevant association between high RPA and recurrent ischaemic events after PCI exists. Individualization of antiplatelet therapy by dose increase or alternative application of novel P2Y₁₂-receptor antagonists might lead to improved cardiovascular outcome in patients with poor responsiveness to conventional antiplatelet therapy. Identification of risk patients who might benefit from tailored therapy by increased net benefit without excess of major bleedings means a challenge. Clinical risk scores might help in the process of risk stratification and therapeutic decision. Subsequently, literature on risk assessment for antiplatelet drug responsiveness and different strategies will be discussed to identify patients who might benefit from personalized antiplatelet strategies.

Zusammenfassung

Ein Eckpfeiler der modernen Kardiologie ist die effektive Plättchenhemmung zur Primärund Sekundärprophylaxe nach koronarer Intervention. Dies stellt eine Herausforderung dar, weil es zunehmende Hinweise gibt, dass das Ansprechen auf die duale antithrombo -zytäre Therapie eine hohe intraindividuelle Variabilität besitzt. Verschiedene Mechanismen u. a. klinische Faktoren, Medikamenten -interaktionen und genetische Einflüsse sind hierfür diskutiert worden. Weiterhin besteht ein nachgewiesener Zusammenhang zwischen gesteigerter thrombozytärer Restaktivität unter dualer plättchenhemmenden Therapie und erhöhtem Risiko für atherothrombotische Komplikationen. Die individualisierte plättchenhemmende Therapie durch Dosis -steigerung oder alternativen Einsatz von neuen P2Y₁₂-Rezeptorantagonisten könnte daher zu einer besseren Prognose bei kardiovaskulären Patienten führen. Eine Herausforderung stellt die Identifizierung von Patienten dar, die von alternativen Behandlungsstrategien durch Prognoseverbesserung ohne wesentliche Zunahme von schwerwiegenden Blutungen profitieren können. Klinische Risiko-Scores könnten helfen, die individualisierte Behandlung kardiovaskulärer Patienten in die klinische Praxis umzusetzen.

Keywords

Antiplatelet

Schlüsselwörter

Plättchenhemmung

• References

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