Precision Antiplatelet Therapy in PCI: Balancing Thrombosis and Bleeding Through Rapid CYP2C19 Genotyping-Precision Antiplatelet Therapy in PCI: Balancing Thrombosis and Bleeding Through Rapid CYP2C19 Genotyping

Video Transcription

Video Summary

This SCI webinar focused on precision antiplatelet therapy after PCI, especially how rapid CYP2C19 genotyping can help balance thrombosis and bleeding risk. Moderator Deepak Bhatt introduced the faculty and emphasized that the session offered CME/MOC credit and required an evaluation afterward.<br /><br />Dr. Dominic Angiolillo reviewed why dual antiplatelet therapy remains challenging. Aspirin plus a P2Y12 inhibitor is standard after PCI, but response to clopidogrel varies widely. Some patients have high platelet reactivity, which is linked to ischemic events and stent thrombosis, while low reactivity increases bleeding risk. He highlighted CYP2C19 as the key genetic determinant of clopidogrel response, but noted that age, BMI, kidney disease, and diabetes also influence effect. He also emphasized that ticagrelor and prasugrel are more potent and predictable, but increase bleeding, making individualized therapy essential.<br /><br />Dr. Naveen Perera summarized the evidence for CYP2C19-guided therapy. Loss-of-function carriers have reduced clopidogrel activation and worse outcomes. Trials such as TAILOR-PCI and POPular Genetics, along with meta-analyses, support genotype-guided selection of therapy: use ticagrelor or prasugrel in loss-of-function carriers, and clopidogrel in non-carriers to reduce bleeding without sacrificing ischemic protection.<br /><br />Dr. Larissa Cavallari presented a real-world case and showed how rapid bedside genotyping can be integrated into clinical workflows, with results available within about an hour. She reviewed genotype phenotypes, decision-support alerts in the electronic record, and practical options for escalation or de-escalation based on genotype and clinical context.<br /><br />In Q&A, the panel discussed platelet function testing, complex high-bleeding-risk patients, and the East Asian paradox. The consensus: genetic testing is practical, increasingly available, and useful when ischemic and bleeding risks compete.

Asset Subtitle

Deepak L. Bhatt, MD, MSCAI; Dominick J. Angiolillo, MD, MPH, FSCAI; Naveen L. Pereira, MD; Larisa H. Cavallari, PharmD, FCCP

Asset Caption

closed captions are computer-generated

Keywords

precision antiplatelet therapy

PCI

CYP2C19 genotyping

clopidogrel

dual antiplatelet therapy

thrombosis risk

bleeding risk

ticagrelor

prasugrel

genotype-guided therapy