Doreen Su-Yin Tan։ Moving Toward Precision in Antiplatelet Therapy – SCSASM2026 Highlights
Doreen Su-Yin Tan, Board Of Directors and President at International Society of Cardiovascular Pharmacotherapy, shared a post on LinkedIn about recent ariticles, adding:
”SCSASM2026 /2026.04.18
Individualisation of Antiplatelets – Sensemaking in 2026
Today, we had an honest conversation, heart-to-heart (no pun intended) as a community. Seven speakers cutting across the entire landscape of coronary syndrome – from acute to chronic coronary syndrome acs ccs – and the implications of CYP2C19 and how it could be deployed in clinical practice.
Summary of our discussions
1. Mark Chan Ching-Hui Sia and Loh Guek Leng kicked off segment 1 Ticagrelor in our contemporary practice – is it overrated? Especially since our local data of 14,812 subjects corroborate with an increased risk of bleeding, with novel risk factors, and even after propensity matching, there is still increased bleeding.
As Mark Chan said, ‘No free lunch in this world’ right?
2. We could potentially recommend that genotype guided P2Y12i therapy might be considered to deescalate therapy, butescalation perhaps cannot be routinely recommended, not because there is no evidence for CYP2C19 LoF being associated with Major Adverse Cardiovascular Events (MACE), but more because of the increased bleeding risk with Ticagrelor without clear ischemic benefit. If one should take action, there would be clear benefit if the switch is done within the first 3 months. Segment 2 was skilfully manoeuvred by Syed Saqib Imran and I piped in on the recent Mattia Galli systemtic review metaanalysis.
3. Should clopidogrel be used over aspirin in the period of CCS following 1 year from index ACS? Recent Valglimi meta-analysis suggests clopidogrel monotherapy is better than aspirin monotherapy in respect to both MACE and bleeding. The positioning of CYP2C19 in the CCS timeframe is unclear.
Veronica T. walked through the Vaglimi SRMA and Gilbert Tan shared a nice State-of-the-Art review
It was a resounding success as it got the community thinking about how we should respond in the age of Precision Medicine, and how might we study the gaps which we don’t have information about. The room was packed full of attendees, ranging from undergraduates to cardiologists to research staff. Kudos to the excellent chair and panelists Hee Hwa Ho Jack Tan and Yashi Saw who skilfully kept time and was still on-point!
Next steps – a community of practice response to how we would use the CYP2C19 information to optimise our care decisions. And continue to study gaps in evidence.”
Title 1: Bleeding Outcomes of Ticagrelor Versus Clopidogrel in Acute Coronary Syndrome Patients: A Multiethnic Database Study
Authors: Guek Leng, Kok Joon, Ganga, Mark Yan Yee, Jack Wei Chieh, Chee Tang, Hee Hwa, Syed Saqib, Doreen Su-Yin
Title 2: Genotype-Guided vs Conventional Oral P2Y12 Inhibitors in Acute Coronary Syndrome: A Combined Analysis of TAILOR-PCI and POPular Genetics
Authors: Mattia Galli, Naveen L Pereira, Ryan J Lennon, Wout W A van den Broek, Daniel M F Claassens, Thomas O Bergmeijer, Yves Rosenberg, Luca Fazzini, Vera H M Deneer, M Hassan Murad, Michael E Farkouh, Charanjit Rihal, Jurrien Ten Berg, Dominick J Angiolillo
Title 3: Clopidogrel versus aspirin for secondary prevention of coronary artery disease: a systematic review and individual patient data meta-analysis
Authors: Marco Valgimigli, Ki Hong Choi, Daniele Giacoppo, Felice Gragnano, Takeshi Kimura, Hirotoshi Watanabe, Hyo-Soo Kim, Jeehoon Kang, Kyung Woo Park, Alf-Åge Pettersen, Mark Woodward, Deepak L Bhatt, Paolo Calabrò, Dominick J Angiolillo, Roxana Mehran, Young Bin Song, Joo-Yong Hahn
Title 4: Aspirin or P2Y12 inhibitor monotherapy in atherosclerotic cardiovascular disease?
Authors: Mattia Galli, Jurrien ten Berg, Marco Valgimigli, Davide Capodanno, Felice Gragnano, Takeshi Kimura, Deepak L Bhatt, C Michael Gibson, Roxana Mehran, Dominick J Angiolillo
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