- Academic Editor
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†These authors contributed equally.
Percutaneous coronary intervention (PCI) is a widely used reperfusion strategy
for coronary artery disease, with millions of procedures performed annually.
Attention has recently been drawn to a unique population, known as
“bi-risk” patients, who have high ischemic and high bleeding risks and
undergo PCI. However, there is currently no established definition or optimal
antithrombotic therapy for this group. Genotype-guided antithrombotic therapy,
which uses cytochrome P450 (CYP) 2C19 gene testing, may offer a more
personalized and precise approach. Nevertheless, recent research has shown that
routine genetic testing to guide treatment in the PCI population does not improve
patient outcomes, preventing it from being routinely recommended in guidelines.
This review proposes, for the first time, the definition of the bi-risk
population and the concept of TAILOR-BIRISK for their treatment
strategies. TAILOR-BIRISK emphasizes de-escalating antithrombotic
treatment and suggests that a short course of dual antiplatelet therapy (DAPT)
followed by monotherapy by either clopidogrel or ticagrelor 60 mg BID (BID, twice daily) could be a
reasonable option for this population. Additionally, the use of CYP2C19
gene testing to guide P2Y