Skip to main content
SpringerLink
Log in

Platelet Function Testing in Contemporary Clinical and Interventional Practice

  • Coronary Artery Disease (D Feldman, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Dual antiplatelet therapy with a combination of aspirin and an inhibitor of the ADP P2Y12 receptor is the recommended treatment for patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention (PCI). However, patients may continue to have ischemic recurrences, including stent thrombosis, which have been linked with the well-known variability in individual response to antiplatelet therapy, and clopidogrel in particular. There are currently several assays available to measure platelet reactivity, and platelet function testing has been shown to be a valuable tool to assess the pharmacodynamic efficacy of antiplatelet drugs. Moreover, platelet reactivity has important prognostic implications, as several studies have shown an association with thrombotic and bleeding events in patients with high and low platelet reactivity, respectively. Consequently, over the past years there has been a plethora of studies investigating the optimal range of platelet reactivity associated with the highest protection against ischemic complications and the lowest risk of bleeding. Given the correlation between on-treatment platelet reactivity and outcomes, the use of platelet function testing has also been advocated to create personalized antiplatelet therapy. Several studies have been conducted in this field, but major clinical trials have failed to demonstrate a benefit of such a strategy in improving clinical outcomes. Indeed, inherent limitations of these trials may have contributed to their failure. The present manuscript provides an overview on the role of platelet function testing in contemporary clinical and interventional practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jneid H, Anderson JL, Wright RS, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2012;126:875–910.

    Article  PubMed  Google Scholar 

  2. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:e362–425.

    Article  PubMed  Google Scholar 

  3. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124:e574–651.

    Article  PubMed  Google Scholar 

  4. Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007;357:2482–94.

    Article  PubMed  Google Scholar 

  5. Angiolillo DJ, Ferreiro JL. Antiplatelet and anticoagulant therapy for atherothrombotic disease: the role of current and emerging agents. Am J Cardiovasc Drugs. 2013;13:233–50.

    Article  PubMed  CAS  Google Scholar 

  6. Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, et al. Variability in individual responsiveness to clopidogrel: clinical implications, management, and future perspectives. J Am Coll Cardiol. 2007;49:1505–16.

    Article  PubMed  CAS  Google Scholar 

  7. Tantry US, Bonello L, Aradi D, et al. Consensus and update on the definition of on-treatment platelet reactivity to ADP associated with ischemia and bleeding. J Am Coll Cardiol. 2013;62:2261–73. Updated expert consensus on the role and definitions of on-treatment platelet reactivity to P2Y12 receptor inhibitors.

    Article  PubMed  CAS  Google Scholar 

  8. Mehta JL, Mohandas B. Aspirin resistance: fact or fiction? A point of view. World J Cardiol. 2010;2:280–8.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Michelson AD, Cattaneo M, Eikelboom JW, et al. Aspirin resistance: position paper of the Working Group on Aspirin Resistance. J Thromb Haemost. 2005;3:1309–11.

    Article  PubMed  CAS  Google Scholar 

  10. Gurbel PA, Bliden KP, DiChiara J, et al. Evaluation of dose-related effects of aspirin on platelet function: results from the Aspirin-Induced Platelet Effect (ASPECT) study. Circulation. 2007;115:3156–64.

    Article  PubMed  CAS  Google Scholar 

  11. Lordkipanidzé M, Pharand C, Schampaert E, et al. A comparison of six major platelet function tests to determine the prevalence of aspirin resistance in patients with stable coronary artery disease. Eur Heart J. 2007;28:1702–8.

    Article  PubMed  CAS  Google Scholar 

  12. Grosser T, Fries S, Lawson JA, Kapoor SC, Grant GR, FitzGerald GA. Drug resistance and pseudoresistance: an unintended consequence of enteric coating aspirin. Circulation. 2013;127:377–85.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  13. Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345:1809–17.

    Article  PubMed  CAS  Google Scholar 

  14. Capodanno D, Patel A, Dharmashankar K, et al. Pharmacodynamic effects of different aspirin dosing regimens in type 2 diabetes mellitus patients with coronary artery disease. Circ Cardiovasc Interv. 2011;4:180–7.

    Article  PubMed  CAS  Google Scholar 

  15. Pettersen AÅ, Seljeflot I, Abdelnoor M, et al. High on-aspirin platelet reactivity and clinical outcome in patients with stable coronary artery disease: results from ASCET (Aspirin Nonresponsiveness and Clopidogrel Endpoint Trial). J Am Heart Assoc. 2012;1:e000703.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  16. Angiolillo DJ. The evolution of antiplatelet therapy in the treatment of acute coronary syndromes: from aspirin to the present day. Drugs. 2012;72:2087–116.

    Article  PubMed  CAS  Google Scholar 

  17. Aradi D, Storey RF, Komócsi A, et al; on behalf of the Working Group on Thrombosis of the European Society of Cardiology. Expert position paper on the role of platelet function testing in patients undergoing percutaneous coronary intervention. Eur Heart J. 2014;35:209–15. Consensus of the European Society of Cardiology on the role and definitions of on-treatment platelet reactivity to P2Y12 receptor inhibitors.

    Google Scholar 

  18. Bonello L, Tantry US, Marcucci R, Working Group on High On-Treatment Platelet Reactivity, et al. Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. J Am Coll Cardiol. 2010;56:919–33.

    Article  PubMed  CAS  Google Scholar 

  19. Brar SS, ten Berg J, Marcucci R, et al. Impact of platelet reactivity on clinical outcomes after percutaneous coronary intervention. A collaborative meta-analysis of individual participant data. J Am Coll Cardiol. 2011;58:1945–54. A meta-analysis demonstrating the correlation between on-clopidogrel high platelet reactivity and outcomes in patients undergoing percutaneous coronary intervention.

    Article  PubMed  Google Scholar 

  20. Matetzky S, Shenkman B, Guetta V, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation. 2004;109:3171–5.

    Article  PubMed  CAS  Google Scholar 

  21. Breet NJ, van Werkum JW, Bouman HJ, et al. Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation. JAMA. 2010;303:754–62.

    Article  PubMed  CAS  Google Scholar 

  22. Angiolillo DJ, Bernardo E, Sabaté M, et al. Impact of platelet reactivity on cardiovascular outcomes in patients with type 2 diabetes mellitus and coronary artery disease. J Am Coll Cardiol. 2007;50:1541–7.

    Article  PubMed  Google Scholar 

  23. Sibbing D, Braun S, Morath T, et al. Platelet reactivity after clopidogrel treatment assessed with point-of-care analysis and early drug-eluting stent thrombosis. J Am Coll Cardiol. 2009;53:849–56.

    Article  PubMed  CAS  Google Scholar 

  24. Bonello L, Paganelli F, Arpin-Bornet M, et al. Vasodilator-stimulated phosphoprotein phosphorylation analysis prior to percutaneous coronary intervention for exclusion of postprocedural major adverse cardiovascular events. J Thromb Haemost. 2007;5:1630–6.

    Article  PubMed  CAS  Google Scholar 

  25. Parodi G, Marcucci R, Valenti R, et al. High residual platelet reactivity after clopidogrel loading and long-term cardiovascular events among patients with acute coronary syndromes undergoing PCI. JAMA. 2011;306:1215–23.

    Article  PubMed  CAS  Google Scholar 

  26. Stone GW, Witzenbichler B, Weisz G, ADAPT-DES Investigators, et al. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet. 2013;382:614–23. The largest study demonstrating the relationship between high on-treatment platelet reactivity to aspirin and clopidogrel measured by VerifyNow P2Y12 and bleeding and ischemic events after drug-eluting stent implantation.

    Article  PubMed  Google Scholar 

  27. Rollini F, Tello-Montoliu A, Angiolillo DJ. Advances in platelet function testing assessing bleeding complications in patients with coronary artery disease. Platelets. 2012;23:537–51. A review article summarizing the relationship between on-treatment platelet reactivity and bleeding events.

    Article  PubMed  CAS  Google Scholar 

  28. Sibbing D, Schulz S, Braun S, et al. Antiplatelet effects of clopidogrel and bleeding in patients undergoing coronary stent placement. J Thromb Haemost. 2010;8:250–6.

    Article  PubMed  CAS  Google Scholar 

  29. Cuisset T, Cayla G, Frere C, et al. Predictive value of post-treatment platelet reactivity for occurrence of post-discharge bleeding after non-ST elevation acute coronary syndrome. Shifting from antiplatelet resistance to bleeding risk assessment? EuroIntervention. 2009;5:325–9.

    Article  PubMed  Google Scholar 

  30. Mokhtar OA, Lemesle G, Armero S, et al. Relationship between platelet reactivity inhibition and non-CABG related major bleeding in patients undergoing percutaneous coronary intervention. Thromb Res. 2010;126:e147–9.

    Article  PubMed  CAS  Google Scholar 

  31. Patti G, Pasceri V, Vizzi V, et al. Usefulness of platelet response to clopidogrel by point-of-care testing to predict bleeding outcomes in patients undergoing percutaneous coronary intervention (from the Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty-Bleeding Study). Am J Cardiol. 2011;107:995–1000.

    Article  PubMed  Google Scholar 

  32. Sairaku A, Nakano Y, Eno S, et al. Platelet function measured using a whole blood aggregometer can predict bleeding events. J Atheroscler Thromb. 2011;18:16–23.

    Article  PubMed  Google Scholar 

  33. Michelson AD, Frelinger 3rd AL, Braunwald E, TRITON-TIMI 38 Investigators, et al. Pharmacodynamic assessment of platelet inhibition by prasugrel vs. clopidogrel in the TRITON-TIMI 38 trial. Eur Heart J. 2009;30:1753–63.

    Article  PubMed  CAS  Google Scholar 

  34. Storey RF, Angiolillo DJ, Patil SB, et al. Inhibitory effects of ticagrelor compared with clopidogrel on platelet function in patients with acute coronary syndromes: the PLATO (PLATelet inhibition and patient Outcomes) PLATELET substudy. J Am Coll Cardiol. 2010;56:1456–62.

    Article  PubMed  CAS  Google Scholar 

  35. Wiviott SD, Braunwald E, McCabe CH, TRITON-TIMI 38 Investigators, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001–15.

    Article  PubMed  CAS  Google Scholar 

  36. Wallentin L, Becker RC, Budaj A, PLATO Investigators, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361:1045–57.

    Article  PubMed  CAS  Google Scholar 

  37. Ferreiro JL, Ueno M, Tello-Montoliu A, et al. Impact of prasugrel reload dosing regimens on high on-treatment platelet reactivity rates in patients on maintenance prasugrel therapy. JACC Cardiovasc Interv. 2013;6:182–4.

    Article  PubMed  Google Scholar 

  38. Laine M, Toesca R, Berbis J, et al. Platelet reactivity evaluated with the VASP assay following ticagrelor loading dose in acute coronary syndrome patients undergoing percutaneous coronary intervention. Thromb Res. 2013;132:e15–8.

    Article  PubMed  CAS  Google Scholar 

  39. Alexopoulos D, Xanthopoulou I, Gkizas V, et al. Randomized assessment of ticagrelor versus prasugrel antiplatelet effects in patients with ST-segment-elevation myocardial infarction. Circ Cardiovasc Interv. 2012;5:797–804.

    Article  PubMed  CAS  Google Scholar 

  40. Parodi G, Valenti R, Bellandi B, et al. Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. J Am Coll Cardiol. 2013;61:1601–6.

    Article  PubMed  CAS  Google Scholar 

  41. Cuisset T, Grosdidier C, Loundou AD, et al. Clinical implications of very low on-treatment platelet reactivity in patients treated with thienopyridine: the POBA study (predictor of bleedings with antiplatelet drugs). JACC Cardiovasc Interv. 2013;6:854–63.

    Article  PubMed  Google Scholar 

  42. Bonello L, Mancini J, Pansieri M, et al. Relationship between post-treatment platelet reactivity and ischemic and bleeding events at 1-year follow-up in patients receiving prasugrel. J Thromb Haemost. 2012;10:1999–2005.

    Article  PubMed  CAS  Google Scholar 

  43. Liang Y, Johnston M, Hirsh J, et al. Relation between clopidogrel active metabolite levels and different platelet aggregation methods in patients receiving clopidogrel and aspirin. J Thromb Thrombolysis. 2012;34:429–36.

    Article  PubMed  CAS  Google Scholar 

  44. Varenhorst C, James S, Erlinge D, et al. Assessment of P2Y(12) inhibition with the point-of-care device VerifyNow P2Y12 in patients treated with prasugrel or clopidogrel coadministered with aspirin. Am Heart J. 2009;157:562.e1-9.

    Article  PubMed  CAS  Google Scholar 

  45. Fuster V, Bhatt DL, Califf RM, et al. Guided antithrombotic therapy: current status and future research direction: report on a National Heart, Lung and Blood Institute working group. Circulation. 2012;126:1645–62.

    Article  PubMed  Google Scholar 

  46. Gurbel PA, Becker RC, Mann KG, et al. Platelet function monitoring in patients with coronary artery disease. J Am Coll Cardiol. 2007;50:1822–34.

    Article  PubMed  CAS  Google Scholar 

  47. Gurbel PA, Bliden KP, Butler K, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009;120:2577–85.

    Article  PubMed  CAS  Google Scholar 

  48. Price MJ, Walder JS, Baker BA, et al. Recovery of platelet function after discontinuation of prasugrel or clopidogrel maintenance dosing in aspirin-treated patients with stable coronary disease: the recovery trial. J Am Coll Cardiol. 2012;59:2338–43.

    Article  PubMed  CAS  Google Scholar 

  49. Angiolillo DJ, Firstenberg MS, Price MJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012;307:265–74.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  50. Campo G, Parrinello G, Ferraresi P, et al. Prospective evaluation of on-clopidogrel platelet reactivity over time in patients treated with percutaneous coronary intervention relationship with gene polymorphisms and clinical outcome. J Am Coll Cardiol. 2011;57:2474–83.

    Article  PubMed  CAS  Google Scholar 

  51. Price MJ, Angiolillo DJ, Teirstein PS, et al. Platelet reactivity and cardiovascular outcomes after percutaneous coronary intervention: a time-dependent analysis of the Gauging Responsiveness with a VerifyNow P2Y12 assay: Impact on Thrombosis and Safety (GRAVITAS) trial. Circulation. 2011;124:1132–7.

    Article  PubMed  Google Scholar 

  52. Bates ER, Lau WC, Angiolillo DJ. Clopidogrel-drug interactions. J Am Coll Cardiol. 2011;57:1251–63.

    Article  PubMed  CAS  Google Scholar 

  53. Steinhubl SR, Oh JJ, Oestreich JH, et al. Transitioning patients from cangrelor to clopidogrel: pharmacodynamic evidence of a competitive effect. Thromb Res. 2008;121:527–34.

    Article  PubMed  CAS  Google Scholar 

  54. Dovlatova NL, Jakubowski JA, Sugidachi A, et al. The reversible P2Y antagonist cangrelor influences the ability of the active metabolites of clopidogrel and prasugrel to produce irreversible inhibition of platelet function. J Thromb Haemost. 2008;6:1153–9.

    Article  PubMed  CAS  Google Scholar 

  55. FDA clopidogrel boxed warning http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm190787.htm. Last access October 2013.

  56. FDA clopidogrel boxed warning http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm190836.htm. Last access October 2013.

  57. Ferreiro JL, Angiolillo DJ. Antiplatelet therapy: clopidogrel plus PPIs-a dangerous combination? Nat Rev Cardiol. 2009;6:392–4.

    Article  PubMed  CAS  Google Scholar 

  58. Angiolillo DJ, Gibson CM, Cheng S, et al. Differential effects of omeprazole and pantoprazole on the pharmacodynamics and pharmacokinetics of clopidogrel in healthy subjects: randomized, placebo-controlled, crossover comparison studies. Clin Pharmacol Ther. 2011;89:65–74.

    Article  PubMed  CAS  Google Scholar 

  59. Frelinger 3rd AL, Lee RD, Mulford DJ, et al. A randomized, 2-period, crossover design study to assess the effects of dexlansoprazole, lansoprazole, esomeprazole, and omeprazole on the steady-state pharmacokinetics and pharmacodynamics of clopidogrel in healthy volunteers. J Am Coll Cardiol. 2012;59:1304–11.

    Article  PubMed  CAS  Google Scholar 

  60. FDA ticagrelor boxed warning http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm263964.htm. Last access October 2013.

  61. Mahaffey KW, Wojdyla DM, Carroll K, et al. Ticagrelor compared with clopidogrel by geographic region in the Platelet Inhibition and Patient Outcomes (PLATO) trial. Circulation. 2011;124:544–54.

    Article  PubMed  CAS  Google Scholar 

  62. Teng R, Maya J, Butler K. Evaluation of the pharmacokinetics and pharmacodynamics of ticagrelor co-administered with aspirin in healthy volunteers. Platelets. 2012;24:615–24.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  63. Pham JP, Ueno M, Tello-Montoliu A, et al. Impact of gastric acid-suppressing therapies on platelet reactivity in patients with coronary artery disease treated with clopidogrel: results of a pharmacodynamic study. J Am Coll Cardiol. 2011;58:1396–8.

    Article  PubMed  CAS  Google Scholar 

  64. Spiliopoulos S, Pastromas G, Katsanos K, et al. Platelet responsiveness to clopidogrel treatment after peripheral endovascular procedures: the PRECLOP study: clinical impact and optimal cutoff value of on-treatment high platelet reactivity. J Am Coll Cardiol. 2013;61:2428–34.

    Article  PubMed  CAS  Google Scholar 

  65. Sibbing D, Steinhubl SR, Schulz S, et al. Platelet aggregation and its association with stent thrombosis and bleeding in clopidogrel-treated patients: initial evidence of a therapeutic window. J Am Coll Cardiol. 2010;56:317–8. This study first demonstrated the existence of a “therapeutic window” of platelet reactivity for balancing efficacy and safety in patients treated with clopidogrel.

    Article  PubMed  Google Scholar 

  66. Mangiacapra F, Patti G, Barbato E, et al. A therapeutic window for platelet reactivity for patients undergoing elective percutaneous coronary intervention: results of the ARMYDA-PROVE (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity for Outcome Validation Effort) study. JACC Cardiovasc Interv. 2012;5:281–9.

    Article  PubMed  Google Scholar 

  67. Angiolillo DJ, Rollini F. Switching from prasugrel to clopidogrel: navigating in unknown waters. JACC Cardiovasc Interv. 2013;6:166–8.

    Article  PubMed  Google Scholar 

  68. Mangiacapra F, Peace A, Barbato E, et al. Thresholds for platelet reactivity to predict clinical events after coronary intervention are different in patients with and without diabetes mellitus. Platelets. 2013 Aug 23. doi:10.3109/09537104.2013.824562.

  69. Angiolillo DJ, Bernardo E, Capodanno D, et al. Impact of chronic kidney disease on platelet function profiles in diabetes mellitus patients with coronary artery disease taking dual antiplatelet therapy. J Am Coll Cardiol. 2010;55:1139–46.

    Article  PubMed  CAS  Google Scholar 

  70. Baber U, Bander J, Karajgikar R, et al. Combined and independent impact of diabetes mellitus and chronic kidney disease on residual platelet reactivity. Thromb Haemost. 2013;110:118–23.

    Article  PubMed  CAS  Google Scholar 

  71. Park DW, Ahn JM, Song HG, et al. Differential prognostic impact of high on-treatment platelet reactivity among patients with acute coronary syndromes versus stable coronary artery disease undergoing percutaneous coronary intervention. Am Heart J. 2013;165:34–42.e1.

    Article  PubMed  Google Scholar 

  72. Varenhorst C, James S, Erlinge D, et al. Genetic variation of CYP2C19 affects both pharmacokinetic and pharmacodynamic responses to clopidogrel but not prasugrel in aspirin-treated patients with coronary artery disease. Eur Heart J. 2009;30:1744–52.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  73. Braun O, Angiolillo DJ, Ferreiro JL, et al. Enhanced active metabolite generation and platelet inhibition with prasugrel compared to clopidogrel regardless of genotype in thienopyridine metabolic pathways. Thromb Haemost. 2013;110:1223–31.

    Google Scholar 

  74. Mega JL, Close SL, Wiviott SD, et al. Cytochrome p-450 polymorphisms and response to clopidogrel. N Engl J Med. 2009;360:354–62.

    Article  PubMed  CAS  Google Scholar 

  75. Wang XD, Zhang DF, Zhuang SW, et al. Modifying clopidogrel maintenance doses according to vasodilator-stimulated phosphoprotein phosphorylation index improves clinical outcome in patients with clopidogrel resistance. Clin Cardiol. 2011;34:332–8.

    Article  PubMed  Google Scholar 

  76. Ari H, Ozkan H, Karacinar A, et al. The effect of high-dose clopidogrel treatment in patients with clopidogrel resistance (the EFFICIENT trial). Int J Cardiol. 2012;157:374–80.

    Article  PubMed  Google Scholar 

  77. Aradi D, Rideg O, Vorobcsuk A, et al. Justification of 150 mg clopidogrel in patients with high on-clopidogrel platelet reactivity. Eur J Clin Invest. 2012;42:384–92.

    Article  PubMed  CAS  Google Scholar 

  78. Hazarbasanov D, Velchev V, Finkov B, et al. Tailoring clopidogrel dose according to multiple electrode aggregometry decreases the rate of ischemic complications after percutaneous coronary intervention. J Thromb Thrombolysis. 2012;34:85–90.

    Article  PubMed  CAS  Google Scholar 

  79. Valgimigli M, Campo G, de Cesare N, et al. Tailoring treatment with tirofiban in patients showing resistance to aspirin and/or resistance to clopidogrel (3T/2R) investigators. Intensifying platelet inhibition with tirofiban in poor responders to aspirin, clopidogrel, or both agents undergoing elective coronary intervention: results from the double-blind, prospective, randomized tailoring treatment with tirofiban in patients showing resistance to aspirin and/or resistance to clopidogrel study. Circulation. 2009;119:3215–22.

    Article  PubMed  CAS  Google Scholar 

  80. Cuisset T, Frere C, Quilici J, et al. Glycoprotein IIb/IIIa inhibitors improve outcome after coronary stenting in clopidogrel nonresponders: a prospective, randomized study. JACC Cardiovasc Interv. 2008;1:649–53.

    Article  PubMed  Google Scholar 

  81. Bonello L, Camoin-Jau L, Arques S, et al. Adjusted clopidogrel loading doses according to vasodilator-stimulated phosphoprotein phosphorylation index decrease rate of major adverse cardiovascular events in patients with clopidogrel resistance: a multicenter randomized prospective study. J Am Coll Cardiol. 2008;51:1404–11.

    Article  PubMed  CAS  Google Scholar 

  82. Bonello L, Camoin-Jau L, Armero S, et al. Tailored clopidogrel loading dose according to platelet reactivity monitoring to prevent acute and subacute stent thrombosis. Am J Cardiol. 2009;103:5–10.

    Article  PubMed  CAS  Google Scholar 

  83. Siller-Matula JM, Francesconi M, Dechant C, et al. Personalized antiplatelet treatment after percutaneous coronary intervention: the MADONNA study. Int J Cardiol. 2013;167:2018–23.

    Article  PubMed  Google Scholar 

  84. Aradi D, Komócsi A, Price MJ, et al. Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention: systematic review and meta-analysis. Int J Cardiol. 2013;167:2140–8.

    Article  PubMed  Google Scholar 

  85. Deharo P, Pons C, Pankert M, et al. Effectiveness of switching ‘hyper responders’ from Prasugrel to Clopidogrel after acute coronary syndrome: The POBA (Predictor of Bleeding with Antiplatelet drugs) SWITCH study. Int J Cardiol. 2013. doi:10.1016/j.ijcard.2013.07.121.

    Google Scholar 

  86. Kerneis M, Silvain J, Abtan J, et al. Switching acute coronary syndrome patients from prasugrel to clopidogrel. JACC Cardiovasc Interv. 2013;6:158–65.

    Article  PubMed  Google Scholar 

  87. Mahla E, Suarez TA, Bliden KP, et al. Platelet function measurement-based strategy to reduce bleeding and waiting time in clopidogrel-treated patients undergoing coronary artery bypass graft surgery: the timing based on platelet function strategy to reduce clopidogrel-associated bleeding related to CABG (TARGET-CABG) study. Circ Cardiovasc Interv. 2012;5:261–9. Study assessing the role of platelet function in patients undergoing coronary artery bypass graft surgery to tailor the timing of surgery after P2Y12 receptor inhibitors discontinuation.

    Article  PubMed  CAS  Google Scholar 

  88. Ferraris VA, Saha SP, Oestreich JH, et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations. Ann Thorac Surg. 2012;94:1761–81.

    Article  PubMed  Google Scholar 

  89. Price MJ, Berger PB, Teirstein PS, et al. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA. 2011;305:1097–105. The first large-scale randomized clinical trial assessing the role of tailored antiplatelet therapy in patients with high on-clopidogrel platelet reactivity.

    Article  PubMed  CAS  Google Scholar 

  90. Trenk D, Stone GW, Gawaz M, et al. A randomized trial of prasugrel versus clopidogrel in patients with high platelet reactivity on clopidogrel after elective percutaneous coronary intervention with implantation of drug-eluting stents: results of the TRIGGER-PCI (Testing Platelet Reactivity In Patients Undergoing Elective Stent Placement on Clopidogrel to Guide Alternative Therapy With Prasugrel) study. J Am Coll Cardiol. 2012;59:2159–64. In this large-scale randomized clinical trial, a strategy based on switch to prasugrel was tested in patients with high on-clopidogrel platelet reactivity after drug-eluting stent implantation.

    Article  PubMed  CAS  Google Scholar 

  91. Collet JP, Cuisset T, Rangé G, et al. Bedside monitoring to adjust antiplatelet therapy for coronary stenting. N Engl J Med. 2012;367:2100–9. In this large-scale randomized clinical trial, a strategy based on platelet function monitoring and tailored antiplatelet therapy in patients with high on-clopidogrel platelet reactivity after percutaneous coronary intervention was tested against a non-monitoring strategy.

    Article  PubMed  CAS  Google Scholar 

  92. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003.

    Article  PubMed  Google Scholar 

  93. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999–3054.

    Article  PubMed  Google Scholar 

  94. Angiolillo DJ, Shoemaker SB, Desai B, et al. Randomized comparison of a high clopidogrel maintenance dose in patients with diabetes mellitus and coronary artery disease: results of the Optimizing Antiplatelet Therapy in Diabetes Mellitus (OPTIMUS) study. Circulation. 2007;115:708–16.

    Article  PubMed  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Francesco Franchi, Dr. Fabiana Rollini, Dr. Elisabetta Ferrante, and Dr. Jung Rae Cho each declare no potential conflict of interest relevant to this article.

Dr. Dominick J. Angiolillo received payment as an individual, as follows for: consulting fee or honorarium from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Merck, Evolva, Abbott Vascular, and PLx Pharma; participation in review activities for Johnson & Johnson, St. Jude, and Sunovion; institutional payments for grants from Bristol-Myers Squibb, Sanofi-Aventis, GlaxoSmithKline, Otsuka, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, and Evolva; and other financial relationships with the James and Esther King Biomedical Research Program.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Francesco Franchi MD, Fabiana Rollini MD, Jung Rae Cho MD, Elisabetta Ferrante PhD & Dominick J. Angiolillo MD, PhD

Authors
  1. Francesco Franchi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabiana Rollini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jung Rae Cho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisabetta Ferrante PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dominick J. Angiolillo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dominick J. Angiolillo MD, PhD.

Additional information

This article is part of the Topical Collection on Coronary Artery Disease

Rights and permissions

Reprints and permissions

About this article

Cite this article

Franchi, F., Rollini, F., Cho, J.R. et al. Platelet Function Testing in Contemporary Clinical and Interventional Practice. Curr Treat Options Cardio Med 16, 300 (2014). https://doi.org/10.1007/s11936-014-0300-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-014-0300-y

Keywords

Search

Navigation