University of Hertfordshire

Advocating cardiovascular precision medicine with P2Y12 receptor inhibitors

Research output: Contribution to journalArticle

  • Max-Paul Winter
  • Erik L Grove
  • Raffaele De Caterina
  • Diana A Gorog
  • Ingo Ahrens
  • Tobias Geisler
  • Paul A Gurbel
  • Udaya Tantry
  • Eliano P Navarese
  • Jolanta M Siller-Matula
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Original languageEnglish
Number of pages14
Pages (from-to)221-234
JournalEuropean heart journal. Cardiovascular pharmacotherapy
Journal publication date1 Oct 2017
Early online date15 Feb 2017
Publication statusPublished - 1 Oct 2017


Antiplatelet therapy with P2Y12-receptor inhibitors has become the cornerstone of medical treatment in patients with acute coronary syndrome treated with percutaneous coronary intervention (PCI). With over 100 million prescriptions filled since its approval, clopidogrel is the most widely used P2Y12-receptor inhibitor. Dual antiplatelet therapy with clopidogrel plus aspirin has been associated with a lower rate of major cardiovascular events in patients after PCI than aspirin monotherapy. However, an alarmingly high number of clopidogrel-treated patients experience adverse thrombotic events. Insufficient P2Y12-inhibition or high on-treatment platelet reactivity to adenosine diphosphate has stimulated the increased use of more potent P2Y12 inhibitors: prasugrel (a third generation thienopyridine) and ticagrelor (a cyclopentyl-triazolo-pyrimidine). However, more potent platelet inhibition and low on-treatment platelet reactivity has resulted in increased major bleeding and higher costs. These limitations have suggested the need for an individualized antiplatelet approach in order to decrease thrombotic events and minimize bleeding. This model of personalized medicine integrates a patient's demographic and biological data (pharmacodynamic, genomic, epigenomic, transcriptomic, and metabolic information) to target therapy in order to maximize efficacy while minimizing bleeding and costs. This review discusses the role of diagnostic tools such as platelet function and pharmacogenomic testing to personalize antiplatelet therapy.


© The Author 2017.

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