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Monitoring of Antiplatelet Therapy

  • Udaya S. Tantry
  • Aung Myat
  • Paul A. GurbelEmail author
Chapter

Abstract

The variability of response to antiplatelet agents and its potential relation to the occurrence of recurrent ischemic events have stimulated the concept of antiplatelet therapy monitoring over the last decade. This has been driven further by the development of user-friendly point-of-care methods to assess platelet reactivity to adenosine diphosphate. Large observational studies have established an independent relation between the results of point-of-care platelet function testing and adverse clinical outcomes, particularly in patients undergoing coronary artery stenting. Furthermore, the concept of a “therapeutic window” for P2Y12 receptor reactivity has been proposed, with an upper threshold associated with ischemic events and a lower threshold associated with bleeding. Prospective randomized trials have, however, failed to demonstrate that tailored antiplatelet therapy based on point-of-care assessment of platelet function is effective in reducing ischemic event occurrences. In the absence of robust prospective evidence to support a personalized approach, decisions regarding antiplatelet therapy rest on patient comorbidity, the large body of observational data, national and international guidelines, and recognition of the fundamental importance of platelet physiology in causing catastrophic events in those with high-risk coronary artery disease.

Keywords

Percutaneous Coronary Intervention Antiplatelet Therapy Stent Thrombosis P2Y12 Receptor Platelet Reactivity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Inova Center for Thrombosis Research and Drug DevelopmentInova Heart and Vascular InstituteFairfaxUSA
  2. 2.King’s College London BHF Centre of Research Excellence, The Rayne Institute, Cardiovascular DivisionSt. Thomas’ HospitalLondonUK

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