polymorphisms, genetic control and laboratory … · polymorphisms, genetic control and laboratory...
TRANSCRIPT
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!!