Personalised antiplatelet therapy during elective percutaneous coronary intervention in patients with chronic coronary syndrome: An international journal of cardiology expert consensus statement.

Abstract

Oral P2Y12 inhibitors represent the mainstay therapy for the prevention of thrombotic complications in patients undergoing percutaneous coronary intervention (PCI) and coronary stent implantation. However, the onset of antiplatelet action of the oral P2Y12 inhibitors is affected by their need to be absorbed in the gastrointestinal tract before becoming systemically available. Following oral intake of P2Y12 inhibitors, the timeframe required for gastrointestinal absorption leads to a periprocedural period of less consistent platelet inhibition at the time of PCI during which patients are potentially at increased risk of thrombotic events. In order to reduce periprocedural ischemic events in patients undergoing PCI, a more rapid platelet inhibition can be obtained with intravenous antiplatelet drugs. Glycoprotein IIb/IIIa receptor inhibitors are effective but their use is limited by bleeding concerns. Cangrelor is an intravenous, direct, and reversible P2Y12 receptor antagonist that provides rapid and predictable platelet inhibition with rapid offset after discontinuation, without a significant increase in major bleeding. In this expert consensus statement, we reviewed available evidence on antiplatelet treatment optimisation in patients undergoing elective PCI, highlighting the importance of a personalised approach.