Genetic testing in antiplatelet therapy – not effective for perioperative bleeding

Nowadays the populations of the developed countries are becoming older, with an obvious increase in the incidence of cardiovascular diseases. This implies a higher risk for complications of invasive treatment and of prolonged antiplatelet therapy in older patients. Additionally, in the era of prasugrel and ticagrelor, the problem of stent thrombosis and recurrent target-vessel ischemic events has declined and is replaced by bleeding complications. If we give strong antiplatelets, we should be aware of their strength, trying to minimize the risk of long-term bleeding. However, we should also be mindful of the risk of periprocedural bleeding, which can be related to technique, medications or possibly genetic factors.
Sianova et al. [1] decided to perform a genetic analysis of single nucleotide polymorphisms (SNPs) of crucial hemostatic platelet receptors (GPIa, GPVI, P2Y12) and correlate their presence with the risk of periprocedural bleeding complications related to coronary angiography or percutaneous coronary intervention (PCI). From a presumably large database of several centers, they selected 73 patients who developed some sort of bleeding events during 30 days after the procedure, unfortunately excluding patients with the most severe types of bleeding (intracranial or fatal bleeding) because “it was impossible to obtain an informed consent for genetic testing from those critically ill patients”. Controls consisted of 331 patients without bleeding. They found no significant association of the SNPs of GPIa 807C/T, GPVI 13254T/C, P2Y12 32C/T, P2Y12 H1/H2 haplotype with increased risk of periprocedural bleeding in patients with ischemic heart disease undergoing coronary angiography or PCI. There was only a trend for higher (according to authors) bleeding risk in the homozygous form of P2Y12 H2 haplotype patients. The most common perioperative bleeding event included was access site hematoma (82.2%), with others below 5%. This is what one could expect, as access site hematoma is most frequent and can even influence outcomes in acute coronary syndrome [2]. It can be due to femoral access, but exact data are missing in the paper, although it is mentioned that in “most participating centers the radial access is preferred”. Instead of genetic factors, the authors found that bleeding was linked with older age, lower body mass index, more frequent arterial hypertension, renal insufficiency, history of previous bleeding, a higher level of leucocytes, lower...


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