Current evidence indicates that dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor is essential for the prevention of thrombotic events after percutaneous coronary interventions. However, dual antiplatelet therapy is associated with increased bleeding which may outweigh the benefits. This has set the foundations for customizing antiplatelet treatments to the individual patient. However, bleeding and ischemic risks are often present in the same patient, making it difficult to achieve this balance. The fact that oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor) have diverse pharmacodynamic profiles that affect clinical outcomes supports the rationale for using platelet function and genetic testing to individualize antiplatelet treatment regimens. Indeed, up to one-third of patients treated with clopidogrel, but a minority of those treated with prasugrel or ticagrelor, exhibit high residual platelet reactivity resulting in an increased thrombotic risk. On the other hand, prasugrel and ticagrelor are frequently associated with low platelet reactivity and increased bleeding risk compared with clopidogrel without providing any additional reduction in ischemic events compared with patients who adequately respond to clopidogrel. The use of platelet function and genetic testing may allow for a guided selection of oral P2Y12 inhibitors. However, the nonuniform results of randomized controlled trials have led guidelines to provide limited recommendations on the implementation of these tests in patients undergoing percutaneous coronary intervention. In light of recent advancements in the field, this consensus document by a panel of international experts fills in the guideline gap by providing updates on the latest evidence in the field as well as recommendations for clinical practice.

中文翻译：

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经皮冠状动脉介入治疗中血小板功能和基因检测的国际共识声明：2024 年更新。


目前的证据表明，阿司匹林加 P2Y12 抑制剂的双重抗血小板治疗对于预防经皮冠状动脉介入治疗后的血栓形成事件至关重要。然而，双重抗血小板治疗与出血增加有关，这可能超过益处。这为为个体患者定制抗血小板治疗奠定了基础。然而，出血和缺血风险通常存在于同一患者身上，因此很难实现这种平衡。口服 P2Y12 抑制剂 （氯吡格雷、普拉格雷和替格瑞洛） 具有不同的药效学特征，影响临床结局，这一事实支持了使用血小板功能和基因检测来个体化抗血小板治疗方案的基本原理。事实上，多达三分之一的接受氯吡格雷治疗的患者，但少数接受普拉格雷或替格瑞洛治疗的患者表现出高残留血小板反应性，导致血栓形成风险增加。另一方面，与氯吡格雷相比，普拉格雷和替格瑞洛通常与低血小板反应性和出血风险增加相关，与对氯吡格雷反应充分的患者相比，没有提供任何额外的缺血事件减少。使用血小板功能和基因检测可能允许指导口服 P2Y12 抑制剂的选择。然而，随机对照试验的不一致结果导致指南对接受经皮冠状动脉介入治疗的患者实施这些检查提供了有限的建议。 鉴于该领域的最新进展，由国际专家小组编写的这份共识文件通过提供该领域最新证据的更新以及临床实践建议来填补指南空白。