Monitoring of platelet function in the setting of glycoprotein IIb/IIIa inhibitor therapy.
The role of the platelet in the pathogenesis of acute coronary syndromes is clearly established. In addition, the beneficial effects of oral and intravenous platelet inhibitor therapies were demonstrated in multiple, large, randomized clinical trials. However, despite these advances, current antiplatelet therapy fails to prevent coronary events in a substantial proportion of patients. One possible explanation for this phenomenon is that antiplatelet medications are administered without monitoring of the response to therapy. For example, oral antiplatelet therapy is administered as a standard dose for all patients, while intravenous inhibitors of the platelet glycoprotein (GP) IIb/IIIa receptor are dosed based on patient body weight. A major limitation of measuring platelet function has been that no practical test exists. The historic gold standard, bleeding time, was a very crude measure of platelet function with limited clinical utility. The current "gold standard," turbidimetric aggregometery, requires a central laboratory and is cumbersome to perform. Fortunately, a number of new tests with rapid turnaround time can be performed at the patient's bedside. This article discusses the details regarding the performance, advantages, disadvantages, and available data related to clinical use of each test in populations with coronary disease and patients treated with antiplatelet therapy.
Thompson
Christopher M
CM
Department of Cardiology, Wilford Hall Medical Center, 2200 Bergquist Drive, Lackland Air Force Base, Texas 78236-5300, USA.
Steinhubl
Steven R
SR
D001792:Blood Platelets / Q000187:drug effects*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*
D019039:Platelet Glycoprotein GPIIb-IIIa Complex