Key result
Platelet function monitoring shows emerging clinical utility for guiding CAD antiplatelet therapy despite potential pitfalls.
Why the study?
The relationships between in vivo platelet function, adverse clinical events, and ex vivo platelet function test results remain largely unknown despite increased focus on antiplatelet therapy responsiveness.
This review highlights the methods, pitfalls, and emerging clinical implications of platelet function monitoring to assess response variability to aspirin and clopidogrel.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We know patients with a low platelet response to aspirin or clopidogrel are at risk of events, but we don't know whether increasing the dose of these drugs will make a difference. The new drugs in development do have less variability in platelet-function tests, but we don't know if this will mean they are better or not. More potent drugs could be good from an efficacy view, but they could also be bad in terms of bleeding side effects. And platelet-aggregation tests at present cannot give us this information.”
Routine platelet function testing should not yet change CAD practice; leaves open whether assay-guided antiplatelet dose escalation improves clinical outcomes.
Studies focused on patient responsiveness to antiplatelet therapies, particularly aspirin and clopidogrel, have increased in recent years. However, the relations of in vivo platelet function and adverse clinical events to results of ex vivo platelet function tests remain largely unknown. This article describes current methods of measuring platelet function in various clinical and research situations and their advantages and disadvantages, reviews evidence for antiplatelet response variability and resistance, discusses the potential pitfalls of monitoring platelet function, and demonstrates emerging data supporting the positive clinical and treatment implications of platelet function testing.
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Gurbel et al. (2007) conducted a review in Coronary Artery Disease. Platelet function monitoring was evaluated. Platelet function monitoring in patients with coronary artery disease has emerging data supporting its positive clinical and treatment implications, despite potential pitfalls.
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