scholarly journals Platelet testing in flow diversion: a review of the evidence

2017 ◽  
Vol 42 (6) ◽  
pp. E5 ◽  
Author(s):  
L. Ian Taylor ◽  
James C. Dickerson ◽  
Robert J. Dambrino ◽  
M. Yashar S. Kalani ◽  
Philipp Taussky ◽  
...  
Keyword(s):  
Platelet Function ◽  
Dual Antiplatelet Therapy ◽  
Interventional Cardiology ◽  
Platelet Inhibition ◽  
Flow Diversion ◽  
Level Of Evidence ◽  
Platelet Function Testing ◽  
Rigorous Testing ◽  
Percutaneous Coronary ◽  
Function Testing

OBJECTIVEAlthough the use of dual antiplatelet therapy with flow diversion is recommended and commonplace, the testing of platelet inhibition is more controversial.METHODSThe authors reviewed the medical literature to establish and describe the physiology of platelet adhesion, the pharmacology of antiplatelet medications, and the mechanisms of the available platelet function tests. Additionally, they present a review of the pertinent neurointerventional and interventional cardiology literature.RESULTSCompeting reports in the neurointerventional literature argue for and against the use of routine platelet function testing, with adjustments to the dosage or medications based on the results. The interventional cardiology literature has also wrestled with this dilemma after percutaneous coronary interventions, with conflicting reports of the benefits of platelet function testing.CONCLUSIONSDespite its prevalence, the benefits of platelet function testing prior to flow diversion are unproven. This practice will likely remain controversial until the level of evidence improves through more rigorous testing and reporting.

scholarly journals Platelet Function Testing and Genotyping for Tailoring Treatment in Complex PCI Patients

2021 ◽  
Vol 15 ◽  
Author(s):  
Athanasios Moulias ◽  
Angeliki Papageorgiou ◽  
Dimitrios Alexopoulos
Keyword(s):  
Platelet Function ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Antiplatelet Treatment ◽  
Platelet Function Testing ◽  
Future Studies ◽  
Percutaneous Coronary ◽  
Treatment Individualization ◽  
Function Testing

Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 receptor inhibitor, is considered the cornerstone of treatment in patients who have undergone percutaneous coronary intervention (PCI). Patients with complex PCI (C-PCI) constitute a special PCI subpopulation, characterized by increased ischemic risk. Identifying the optimal DAPT strategy is often challenging and remains controversial in this setting. In an attempt to balance ischemic and bleeding risks in C-PCI patients receiving DAPT, treatment individualization regarding potency and duration has evolved as a feasible approach. Platelet function testing and genotyping have been evaluated in several trials with conflicting and mostly neutral results. The aim of this review is to critically appreciate the role of these tools for antiplatelet treatment tailoring specifically in C-PCI patients. Because existing evidence is limited, dedicated future studies are warranted to elucidate the utility of platelet function testing and genotyping in C-PCI.

Platelet function testing and risk of bleeding complications

2010 ◽  
Vol 103 (06) ◽  
pp. 1128-1135 ◽  
Author(s):  
José Luis Ferreiro ◽  
Dirk Sibbing ◽  
Dominick Angiolillo
Keyword(s):  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Platelet Inhibition ◽  
Bleeding Complications ◽  
Individual Response ◽  
Bleeding Events ◽  
Platelet Function Testing ◽  
Risk Of Bleeding ◽  
Potential Applications ◽  
Function Testing

SummaryAntiplatelet therapy has a key role in preventing atherothrombotic events in patients with coronary artery disease, particularly in those undergoing revascularisation procedures. However, this may occur at the expense of an increase risk of bleeding. Therefore, the balance between thrombotic and bleeding events is critical in order to achieve optimal outcomes. Since there is a broad variability in individual response profiles to antiplatelet therapy, these outcomes (thrombosis vs. bleeding) may depend on the level of platelet inhibition achieved in a given subject. Platelet function assays have emerged as a useful tool for its potential to determine patients at a higher risk of ischaemic and bleeding complications. The present manuscript will review the available evidence associating platelet function testing with adverse clinical outcomes, in particular bleeding, and their potential applications in lieu of novel and more potent antithrombotic agents that will be introduced into clinical practice in the near future.

Abstract 1032: High Clopidogrel Maintenance Dosing in Patients with Inadequate Platelet Inhibition: Functional Insights on Thienopyridine Usage According to Updated ACC/AHA/SCAI 2005 Guidelines for Percutaneous Coronary Interventions

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Dominick J Angiolillo ◽  
Marco A Costa ◽  
Steven B Shoemaker ◽  
Bhaloo Desai ◽  
Yuan Hang ◽  
...  
Keyword(s):  
Steady State ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Maintenance Dose ◽  
Dual Antiplatelet Therapy ◽  
Platelet Inhibition ◽  
Percutaneous Coronary Interventions ◽  
Percutaneous Coronary ◽  
Risk Patients

Background: Clopidogrel under-dosing is a cause of inadequate platelet inhibition. Inadequate clopidogrel-induced antiplatelet effects have been associated with an increased risk of stent thrombosis. Updated guidelines for percutaneous coronary interventions (PCI) recommend to increase the dose of clopidogrel to 150mg in high risk patients if <50% platelet inhibition is demonstrated. However, to date there are no studies which have evaluated the functional impact of this recommendation. The aim of this study was determine the functional impact of a 150mg maintenance dose of clopidogrel in patients with 50% platelet inhibition while in their steady state phase of dual antiplatelet therapy. Methods: Platelet inhibition was screened by means of the VerifyNow P2Y 12 assay in patients in a steady state phase of dual antiplatelet therapy. Patients with <50% platelet inhibition were treated with 150mg of clopidogrel for one-month. Adenosine diphosphate-induced aggregation using light transmittance aggregometry and P2Y 12 reactivity ratio determined by vasodilator-stimulated phosphoprotein-phosphorylation analysis were also performed. Results: A total of 32 patients were screened to identify 20 with <50% platelet inhibition. Platelet inhibition increased from 28.3±12% to 43.2±18% in patients treated with 150mg of clopidogrel (p=0.004; primary endpoint). All other functional measures also showed that a high maintenance dose of clopidogrel reduces platelet function (Table ) . The degree of platelet inhibition achieved following one-month treatment with high dose clopidogrel broadly varied and only eight (40%) patients yielded a degree of platelet inhibition ≥50%. Conclusions: The use of a 150mg maintenance dose of clopidogrel in high risk patients with <50% platelet inhibition increases platelet inhibition. However, the antiplatelet effects achieved are non-uniform and a considerable number of patients persist with elevated platelet function. Platelet function analysis pre and post high clopidogrel maintenance dose therapy

P1931Effect of de-escalated switching dual antiplatelet therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: real-world data from a nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C.-Y Hsu ◽  
J.-S Yeh ◽  
C.-Y Huang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Function Testing

Abstract Background Recently, both unguided (platelet function testing independent) and guided (platelet function testing dependent) DAPT de-escalation strategies have been investigated in different clinical studies but the data is still limited and conflicting. The aim of this study was to examine the effect of switching dual antiplatelet therapy (DAPT) on the major vascular risk after acute myocardial infarction (AMI) in patients undergoing percutaneous coronary intervention (PCI) by using Taiwan National Health Insurance Research Database. Methods In total, 1,903 and 4,059 patients defined as switched to aspirin and clopidogrel (switched DAPT) and continuation of aspirin and ticagrelor (unswitched DAPT) cohort, respectively who had received PCI during AMI hospitalization, on aspirin and ticagrelor initially and without occurring adverse events at 3 months were evaluated between 2013 and 2015. An inverse probability treatment of weighted approach was adopted to balance the baseline differences between two groups and Cox proportional hazard regression and competing risk regression were used to evaluated the effect of switching DAPT on death, AMI readmission, major bleeding and non-major clinically relevant bleeding. Results The incidence rates (per 100 person-year) of death and AMI readmission were 3.97 (95% confidence interval [CI] = 3.19–4.84) and 3.84 (95% CI = 3.09–4.73) in switched cohort and 1.83 (95% CI = 1.47–2.24) and 2.23 (95% CI = 1.82–2.68) in unswitched cohort, respectively. After adjustment for patients' clinical variables, switched cohort had higher risk of death (adjusted hazard ratio = 2.18, 95% CI = 1.62–2.93, P<0.001), and AMI readmission (adjusted sub-distribution ratio = 1.72, 95% CI = 1.27–2.34, P<0.001) compared to these in unswitched cohort; however, there was no difference in the risk of bleeding. Subgroup analysis showed a similar findings in many specific groups, except the patients who were younger age and had lower comorbidity score. Conclusion Switching DAPT might increase the risk of death and AMI readmission among patients with AMI undergoing PCI.

scholarly journals Receptor Inhibitors in Acute Coronary Syndromes: What Is New on the Horizon?

2013 ◽  
Vol 2013 ◽  
pp. 1-15 ◽  
Author(s):  
Adriana Dana Oprea ◽  
Wanda M. Popescu
Keyword(s):  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Acute Coronary Syndromes ◽  
Point Of Care ◽  
Variable Response ◽  
Pharmacodynamic Interaction ◽  
Platelet Function Testing ◽  
Percutaneous Coronary ◽  
Coronary Syndromes ◽  
Function Testing

Dual antiplatelet therapy with aspirin and a P2Y12receptor inhibitor represents the cornerstone therapy for patients with acute coronary syndromes or undergoing percutaneous interventions, leading to a reduction of subsequent ischemic events. Variable response to clopidogrel has received close attention, and pharmacokinetic, pharmacodynamic, and pharmacogenomic factors have been identified as culprits. This led to the introduction of newer, potentially safer, and more effective antiplatelet agents (prasugrel and ticagrelor). Additionally, several point-of-care assays of platelet function have been developed in recent years to rapidly screen individuals on antiplatelet therapy. While the routine use of platelet function testing is uncertain and not currently recommended, it may be useful in instances when the degree of platelet inhibition may be uncertain such as high-risk patients undergoing percutaneous coronary intervention or when there may be a suspected pharmacodynamic interaction with other drugs. The current paper focuses on the P2Y12receptor inhibitors and their pharmacogenetics and indications in patients with acute coronary syndromes or receiving percutaneous coronary interventions as well as the applicability of platelet function testing in this clinical context.

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