Journal of Clinical Medicine

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Special Issue Editor

Prof. Dr. Jurriën ten Berg

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Guest Editor

1. Interventional Cardiologist St Antonius Hospital, Nieuwwegein, The Netherlands
2. Professor "antithrombotic therapy in cardiac catheter interventions" at University Medical Center Maastricht, Maastricht, The Netherlands
Interests: acute coronary syndrome; antithrombotic therapy; interventional cardiology; pharmacogenetics; thrombosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The optimal antithrombotic therapy in patients with acute coronary syndrome or undergoing percutaneous coronary stenting is still controversial. The duration of dual antiplatelet therapy, the role of monotherapy with P2Y12 inhibition as well as additional Non-vitamin-K-anticoagulation (NOAC) in particular, need further research. How to use antithrombotic therapy in patients undergoing non-coronary interventions (Transcatheter aortic valve implantation, Mitraclip and other devices) is largely unknown. This Special Issue on Antithrombotic Treatments: From Clinical Practice to Clinical Outcome will address these controversies in antithrombotic treatments.

Prof. Dr. Jurriën ten Berg
Guest Editor

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Keywords

antithrombotic therapy
acute coronary syndrome
percutaneous coronary intervention
transcatheter aortic valve implantation
Mitraclip
P2Y12 inhibition
non-vitamin-K-anticoagulation

Published Papers (2 papers)

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Research

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15 pages, 626 KiB

Open AccessArticle

Differential Impact of Cytochrome 2C19 Allelic Variants on Three Different Platelet Function Tests in Clopidogrel-Treated Patients

by Renske H. Olie, Rachelle R. K. Hensgens, Petal A. H. M. Wijnen, Leo F. Veenstra, Bianca T. A. de Greef, Minka J. A. Vries, Paola E. J. van der Meijden, Jurriën M. ten Berg, Hugo ten Cate, Otto Bekers and Yvonne M. C. Henskens

J. Clin. Med. 2021, 10(17), 3992; https://doi.org/10.3390/jcm10173992 - 3 Sep 2021

Cited by 2 | Viewed by 1829

Abstract

On-treatment platelet reactivity in clopidogrel-treated patients can be measured with several platelet function tests (PFTs). However, the agreement between different PFTs is only slight to moderate. Polymorphisms of the CYP2C19 gene have an impact on the metabolization of clopidogrel and, thereby, have an impact on on-treatment platelet reactivity. The aim of the current study is to evaluate the differential effects of the CYP2C19 genotype on three different PFTs. Methods: From a prospective cohort study, we included patients treated with clopidogrel following percutaneous coronary intervention (PCI). One month after PCI, we simultaneously performed three different PFTs; light transmission aggregometry (LTA), VerifyNow P2Y12, and Multiplate. In whole EDTA blood, genotyping of the CYP2C19 polymorphisms was performed. Results: We included 308 patients treated with clopidogrel in combination with aspirin (69.5%) and/or anticoagulants (33.8%) and, based on CYP2C19 genotyping, classified them as either extensive (36.4%), rapid (34.7%), intermediate (26.0%), or poor metabolizers (2.9%). On-treatment platelet reactivity as measured by LTA and VerifyNow is significantly affected by CYP2C19 metabolizer status (p < 0.01); as metabolizer status changes from rapid, via extensive and intermediate, to poor, the mean platelet reactivity increases accordingly (p < 0.01). On the contrary, for Multiplate, no such ordering of metabolizer groups was found (p = 0.10). Conclusions: For VerifyNow and LTA, the on-treatment platelet reactivity in clopidogrel-treated patients correlates well with the underlying CYP2C19 polymorphism. For Multiplate, no major effect of genetic background could be shown, and effects of other (patient-related) variables prevail. Thus, besides differences in test principles and the influence of patient-related factors, the disagreement between PFTs is partly explained by differential effects of the CYP2C19 genotype. Full article

(This article belongs to the Special Issue Antithrombotic Treatments: From Clinical Practice to Clinical Outcome)

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Review

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20 pages, 900 KiB

Open AccessReview

Current and Future Insights for Optimizing Antithrombotic Therapy to Reduce the Burden of Cardiovascular Ischemic Events in Patients with Acute Coronary Syndrome

by Abi Selvarajah, Anne H. Tavenier, Enrico Fabris, Maarten A. H. van Leeuwen and Renicus S. Hermanides

J. Clin. Med. 2022, 11(19), 5605; https://doi.org/10.3390/jcm11195605 - 23 Sep 2022

Cited by 1 | Viewed by 1998

Abstract

The pharmacological treatment strategies for acute coronary syndrome (ACS) in recent years are constantly evolving to develop more potent antithrombotic agents, as reflected by the introduction of more novel P2Y₁₂ receptor inhibitors and anticoagulants to reduce the ischemic risk among ACS patients. Despite the substantial improvements in the current antithrombotic regimen, a noticeable number of ACS patients continue to experience ischemic events. Providing effective ischemic risk reduction while balancing bleeding risk remains a clinical challenge. This updated review discusses the currently approved and widely used antithrombotic agents and explores newer antithrombotic treatment strategies under development for the initial phase of ACS. Full article

(This article belongs to the Special Issue Antithrombotic Treatments: From Clinical Practice to Clinical Outcome)

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