Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella Review
Angelo Oliva,1,2 Davide Cao,1,3 Alessandro Spirito,1 Johny Nicolas,1 Brunna Pileggi,1,4 Karim Kamaleldin,1 Birgit Vogel,1 Roxana Mehran1 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; 2Cardio Center, Humanitas Research Hospi...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-11-01
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| Series: | Pharmacogenomics and Personalized Medicine |
| Subjects: | |
| Online Access: | https://www.dovepress.com/personalized-approaches-to-antiplatelet-treatment-for-cardiovascular-d-peer-reviewed-fulltext-article-PGPM |
| _version_ | 1797636615133200384 |
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| author | Oliva A Cao D Spirito A Nicolas J Pileggi B Kamaleldin K Vogel B Mehran R |
| author_facet | Oliva A Cao D Spirito A Nicolas J Pileggi B Kamaleldin K Vogel B Mehran R |
| author_sort | Oliva A |
| collection | DOAJ |
| description | Angelo Oliva,1,2 Davide Cao,1,3 Alessandro Spirito,1 Johny Nicolas,1 Brunna Pileggi,1,4 Karim Kamaleldin,1 Birgit Vogel,1 Roxana Mehran1 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; 2Cardio Center, Humanitas Research Hospital IRCCS Rozzano, Milan, Italy; 3Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy; 4Department of Cardiopneumonology, Heart Institute of the University of Sao Paulo, Sao Paulo, BrazilCorrespondence: Roxana Mehran, Tel +1-212-659-9649, Email roxana.mehran@mountsinai.orgAbstract: 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 long-term 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.Keywords: antiplatelet therapy, cardiovascular disease, P2Y12 inhibitor, aspirin |
| first_indexed | 2024-03-11T12:36:34Z |
| format | Article |
| id | doaj.art-5c73eb0112644f43bc78967d1e99bc76 |
| institution | Directory Open Access Journal |
| issn | 1178-7066 |
| language | English |
| last_indexed | 2024-03-11T12:36:34Z |
| publishDate | 2023-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Pharmacogenomics and Personalized Medicine |
| spelling | doaj.art-5c73eb0112644f43bc78967d1e99bc762023-11-05T18:06:31ZengDove Medical PressPharmacogenomics and Personalized Medicine1178-70662023-11-01Volume 1697399087857Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella ReviewOliva ACao DSpirito ANicolas JPileggi BKamaleldin KVogel BMehran RAngelo Oliva,1,2 Davide Cao,1,3 Alessandro Spirito,1 Johny Nicolas,1 Brunna Pileggi,1,4 Karim Kamaleldin,1 Birgit Vogel,1 Roxana Mehran1 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; 2Cardio Center, Humanitas Research Hospital IRCCS Rozzano, Milan, Italy; 3Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy; 4Department of Cardiopneumonology, Heart Institute of the University of Sao Paulo, Sao Paulo, BrazilCorrespondence: Roxana Mehran, Tel +1-212-659-9649, Email roxana.mehran@mountsinai.orgAbstract: 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 long-term 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.Keywords: antiplatelet therapy, cardiovascular disease, P2Y12 inhibitor, aspirinhttps://www.dovepress.com/personalized-approaches-to-antiplatelet-treatment-for-cardiovascular-d-peer-reviewed-fulltext-article-PGPMantiplatelet therapycardiovascular diseasep2y12 inhibitoraspirin |
| spellingShingle | Oliva A Cao D Spirito A Nicolas J Pileggi B Kamaleldin K Vogel B Mehran R Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella Review Pharmacogenomics and Personalized Medicine antiplatelet therapy cardiovascular disease p2y12 inhibitor aspirin |
| title | Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella Review |
| title_full | Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella Review |
| title_fullStr | Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella Review |
| title_full_unstemmed | Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella Review |
| title_short | Personalized Approaches to Antiplatelet Treatment for Cardiovascular Diseases: An Umbrella Review |
| title_sort | personalized approaches to antiplatelet treatment for cardiovascular diseases an umbrella review |
| topic | antiplatelet therapy cardiovascular disease p2y12 inhibitor aspirin |
| url | https://www.dovepress.com/personalized-approaches-to-antiplatelet-treatment-for-cardiovascular-d-peer-reviewed-fulltext-article-PGPM |
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