Monitoring and tailoring the P2Y12 ADP receptor blocker therapy

Czech version

Authors: Tomáš Bolek; Barbora Korpallová; Lukáš Urban; Jakub Marko; Jakub Benko; Dana Prídavková
Authors‘ workplace: I. Interná klinika JLF UK a UN Martin, Slovenská republika
Published in: Vnitř Lék 2020; 66(1): 51-58
Category:

Overview

P2Y12 ADP receptor blocker (ADPRB) treatment forms currently the basis of pharmacotherapy in acute coronary syndrome (ACS) patients, and in patients after percutaneous coronary interventions (PCI). However, nowadays, there are lots of data demonstrating an association between insufficient ADPRB on-treatment response and the risk of ischemic events, including stent trombosis, which is an uncommon but life-threatening complication in patients after PCI. High on-treatment platelet reactivity may be detected with several laboratory tests. Light transsmition aggregometry with ADP induction is so far considered to be a „golden standard“, and VASP (vasodilator stimulated phosphoprotein) phosphorylation assessement using flow cytometry is probably the most specific test for the assessment of insuficient platelet response. If high on-treatment platelet reactivity is detected, this phenomenon migh be overcome with increased ADPRB dosing, ADPRB switch (e.g. switch of clopidogrel to prasugrel), or with the addition of other antiplatelet agent. The administration of cangrelor – a new parenteral ADPRB – might be another perspective way how to overcome the phenomenon of insuficient ADPRB on-treatment response. The article summarizes current knowledge about the ADPRB resistance and the risk of ischemic events in patients undergoing PCI, the current approaches for the detection of this resistance, and summarizes the current approaches for overcoming this phenomenon.

Keywords:

percutaneous coronary intervention – personalized medicine – high on-treatment platelet reactivity – P2Y12 ADP blockers

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