January 10, 2020Open Access
Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s
Structured PICO
Should platelet function tests be used to guide escalation or de-escalation of antiplatelet therapy in patients with coronary artery disease?
P
Population
Patients with coronary artery disease, particularly acute coronary syndrome
I
Intervention
Platelet function tests (PFTs) to guide antiplatelet therapy (escalation or de-escalation)
This review highlights that while PFT-guided escalation of antiplatelet therapy has largely failed in trials, PFTs may have a role in guiding de-escalation strategies to reduce bleeding risk in ACS patients.
Abstract
In the field of antithrombotics, precision medicine is of particular interest, as it may lower the incidence of potentially life-threatening side effects. Indeed, antiplatelet drugs such as P2Y12 inhibitors are one of the most common causes of emergency admissions for drug-related adverse events. The last ten years have seen a continuous debate on whether platelet function tests (PFTs) should be used to tailor antiplatelet drugs to cardiovascular patients. Large-scale randomized studies investigating the escalation of antiplatelet therapies according to the results of PFTs were mostly negative. Potent P2Y12 inhibitors are recommended as a first-line treatment in acute coronary syndrome patients, bringing the bleeding risk at the forefront. De-escalation from prasugrel or ticagrelor to clopidogrel is now considered, with or without the use of a PFT. This review covers recent advances in escalation and de-escalation strategies based on PFTs in various clinical settings. It also describes the main features of the most popular platelet function tests as well as the potential added value of genetic testing. Finally, we detail practical suggestions on how PFTs could be used in clinical practice.