POLYMORPHISMS, GENETIC CONTROL AND LABORATORY MONITORING IN PERCUTANEOUS CORONARY...

POLYMORPHISMS, GENETIC CONTROL ANDLABORATORY MONITORING IN PERCUTANEOUS CORONARY

INTERVENTIONS

Dimitriadis Dimokritos MD interventional cardiologistEuromedica ‘Kyanous Stavros, THESSALONIKI

No conflict of interest

x

GP = glycoprotein; PAR = protease-activated receptor; TP = thromboxane A2 / prostaglandin H2.

Storey RF. Curr Pharm Des. 2006;12:1255-1259.

TARGETS !!!!

ThromboxaneA

2

5HT

P2Y 12

ADP ADPADP

5HT

PLATELETACTIVATION

P2Y 15HT 2A

PAR-1

PAR-4

Densegranule

Thrombingeneration

Shapechange

aIIbb3

aIIbb3

FibrinogenaIIbb3

Aggregation

AmplificationAlpha

granule

Coagulation factorsInflammatory mediators

TP a

Coagulation

GPVI

Collagen

ATPATP

P2X 1

ASPIRIN

x TICLOPIDINECLOPIDOGRELPRASUGREL

ACTIVE METABOLITE

x TICAGRELOR CANGRELOR

GP IIb/IIIa ANTAGONISTS

xx

VORAPAXARATOPAXAR

x

TERUTROBAN

x

HEPARINS

FONDAPARINUX

BIVALIRUDIN

RIVAROXABAN

APIXABANDABIGATRAN Thrombin

1

Resistance!!

ACC/AHA guidelines 2011 PCI, 2012 ACS

change

to novel

Antiplatelets!!