Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella Review

Angelo Oliva, Davide Cao, Alessandro Spirito, Johny Nicolas, Brunna Pileggi, Karim Kamaleldin, Birgit Vogel, Roxana Mehran

Research output: Contribution to journalReview articlepeer-review

Abstract

Antiplatelet therapy is the cornerstone of antithrombotic prevention in patients with established atherosclerosis, since it has been proven to reduce coronary, cerebrovascular, and peripheral thrombotic events. However, the protective effect of antiplatelet agents is counterbalanced by an increase of bleeding events that impacts on patients’ mortality and morbidity. Over the last years, great efforts have been made toward personalized antithrombotic strategies according to the individual bleeding and ischemic risk profile, aiming to maximizing the net clinical benefit. The development of risk scores, consensus definitions, and the new promising artificial intelligence tools, as well as the assessment of platelet responsiveness using platelet function and genetic testing, are now part of an integrated approach to tailored antithrombotic management. Moreover, novel strategies are available including dual antiplatelet therapy intensity and length modulation in patients undergoing myocardial revascularization, the use of P2Y12 inhibitor monotherapy for longterm secondary prevention, the implementation of parenteral antiplatelet agents in high-ischemic risk clinical settings, and combination of antiplatelet agents with low-dose factor Xa inhibitors (dual pathway inhibition) in patients suffering from polyvascular disease. This review summarizes the currently available evidence and provides an overview of the principal risk-stratification tools and antiplatelet strategies to inform treatment decisions in patients with cardiovascular disease.

Original languageEnglish
Pages (from-to)973-990
Number of pages18
JournalPharmacogenomics and Personalized Medicine
Volume16
DOIs
StatePublished - 2023

Keywords

  • P2Y inhibitor
  • antiplatelet therapy
  • aspirin
  • cardiovascular disease

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