Towards Personalized Antithrombotic Treatments: Focus on P2Y<sub>12</sub> Inhibitors and Direct Oral Anticoagulants.

Détails

ID Serval
serval:BIB_AC8A16216FE8
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Towards Personalized Antithrombotic Treatments: Focus on P2Y<sub>12</sub> Inhibitors and Direct Oral Anticoagulants.
Périodique
Clinical pharmacokinetics
Auteur⸱e⸱s
Terrier J., Daali Y., Fontana P., Csajka C., Reny J.L.
ISSN
1179-1926 (Electronic)
ISSN-L
0312-5963
Statut éditorial
Publié
Date de publication
12/2019
Peer-reviewed
Oui
Volume
58
Numéro
12
Pages
1517-1532
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; Review
Publication Status: ppublish
Résumé
Oral anticoagulants and antiplatelet drugs are commonly prescribed to lower the risk of cardiovascular diseases, such as venous and arterial thrombosis, which represent the leading causes of mortality worldwide. A significant percentage of patients taking antithrombotics will nevertheless experience bleeding or recurrent ischemic events, and this represents a major public health issue. Cardiovascular medicine is now questioning the one-size-fits-all policy, and more personalized approaches are increasingly being considered. However, the available tools are currently limited and they are only moderately able to predict clinical events or have a significant impact on clinical outcomes. Predicting concentrations of antithrombotics in blood could be an effective means of personalization as they have been associated with bleeding and recurrent ischemia. Target concentration interventions could take advantage of physiologically based pharmacokinetic (PBPK) and population-based pharmacokinetic (POPPK) models, which are increasingly used in clinical settings and have attracted the interest of governmental regulatory agencies, to propose dosages adapted to specific population characteristics. These models have the benefit of combining parameters from different sources, such as experimental in vitro data and patients' demographic, genetic, and physiological in vivo data, to characterize the dose-concentration relationships of compounds of interest. As such, they can be used to predict individual drug exposure. In the near future, these models could therefore be a valuable means of predicting personalized antithrombotic blood concentrations and, hopefully, of preventing clinical non-response or bleeding in a given patient. Existing approaches for personalization of antithrombotic prescriptions will be reviewed using practical examples for P2Y <sub>12</sub> inhibitors and direct oral anticoagulants. The review will additionally focus on the existing PBPK and POPPK models for these two categories of drugs. Lastly, we address potential scenarios for their implementation in clinics, along with the main limitations and challenges.
Mots-clé
Administration, Oral, Anticoagulants/administration & dosage, Anticoagulants/adverse effects, Anticoagulants/pharmacokinetics, Cardiovascular Diseases/drug therapy, Humans, Models, Biological, Precision Medicine/methods, Purinergic P2Y Receptor Antagonists/administration & dosage, Purinergic P2Y Receptor Antagonists/adverse effects, Purinergic P2Y Receptor Antagonists/pharmacokinetics
Pubmed
Web of science
Création de la notice
19/09/2020 15:28
Dernière modification de la notice
07/10/2021 5:39
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