MedicalResearch.com Interview with:
Prof. Dr. med. Dirk Sibbing, MHBA, FESC
Oberarzt, Medizinische Klinik und Poliklinik I
Ludwig-Maximilians-Universität (LMU) München
Chairperson ESC Working Group on Thrombosis
MedicalResearch.com: What is the background for this consensus statement? What are the main findings that led to these conclusions?
Response: The availability of different P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment concepts. Such concepts may include escalation or de-escalation of P2Y12 inhibiting therapy.
Alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early vs. chronic treatment) and patient risk for ischemic and bleeding complications. As always in clinical medicine, guidance by means of biomarkers or risk scores is always helpful and warranted. Here specifically, a tailored DAPT approach may be potentially guided by platelet function (PFT) or genetic testing.
MedicalResearch.com: What should readers take away from your report?
Response: According to large-scale trials and the respective guidelines, clopidogrel is the recommended P2Y12 inhibitor in stable patients, while prasugrel and ticagrelor are recommended, in the absence of contraindications, in patients with ACS. Thus, physicians should abide, whenever possible, with guideline recommendations on the choice of DAPT as they have the highest level of evidence. However, real-life is more complex and for the individual patient, multiple factors, including thrombotic and bleeding risk as well as socio-economic considerations, may play a role in the choice of P2Y12 inhibitor therapy. In such scenarios, the use of PFT and genetic testing is proposed by our consensus statement as an optional tool to guide clinical decision-making on the choice of P2Y12 inhibiting therapy.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future strategy trials (most likely investigator initiated trials) should focus on various areas of clinical use (DAPT escalation, DAPT de-escalation, timing of surgery) to further refine the field of personalizing P2Y12 receptor inhibitor treatment in patients undergoing PCI. We are still at the very beginning of individualized treatment concepts in the field of antiplatelet therapy for PCI.
MedicalResearch.com: Is there anything else you would like to add?
Response: Consensus statements, like ours aim at providing a balanced point of view for a specific clinical setting. They provide guidance for the clinician where society guidelines cannot expand on certain specific topics. In my opinion, as the leading author of this consensus document we succeeded in doing this and we hope that the paper is helpful for the cardiovascular community.
Dr. Sibbing reports grants and personal fees from Roche Diagnostics, grants and personal fees from Daiichi Sankyo, personal fees from Bayer, personal fees from Pfizer, personal fees from Sanofi, personal fees from Haemonetics S.A.,
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