title: Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate.
abstract: The addition of clopidogrel to aspirin treatment reduces ischemic events in a wide range of patients with cardiovascular disease. However, recurrent ischemic event occurrence during dual antiplatelet therapy, including stent thrombosis, remains a major concern. Platelet function measurements during clopidogrel treatment demonstrated a variable and overall modest level of P2Y(12) inhibition. High on-treatment platelet reactivity to adenosine diphosphate (ADP) was observed in selected patients. Multiple studies have now demonstrated a clear association between high on-treatment platelet reactivity to ADP measured by multiple methods and adverse clinical event occurrence. However, the routine measurement of platelet reactivity has not been widely implemented and recommended in the guidelines. Reasons for the latter include: 1) a lack of consensus on the optimal method to quantify high on-treatment platelet reactivity and the cutoff value associated with clinical risk; and 2) limited data to support that alteration of therapy based on platelet function measurements actually improves outcomes. This review provides a consensus opinion on the definition of high on-treatment platelet reactivity to ADP based on various methods reported in the literature and proposes how this measurement may be used in the future care of patients.
authors.affiliation: Department of Cardiology, Institut National de la Santè et de la Recherche Médicale Unité Mixte de Recherche 608, Hôpital Universitaire Nord, Faculté de Médecine, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonello
authors.forename: Udaya S
authors.initials: US
authors.lastname: Tantry
authors.forename: Rossella
authors.initials: R
authors.lastname: Marcucci
authors.forename: Ruediger
authors.initials: R
authors.lastname: Blindt
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Richard
authors.initials: R
authors.lastname: Becker
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Marco
authors.initials: M
authors.lastname: Cattaneo
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Christian
authors.initials: C
authors.lastname: Gachet
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Jennings
authors.forename: Dean
authors.initials: D
authors.lastname: Kereiakes
authors.forename: Dirk
authors.initials: D
authors.lastname: Sibbing
authors.forename: Dietmar
authors.initials: D
authors.lastname: Trenk
authors.forename: Jochem W
authors.initials: JW
authors.lastname: Van Werkum
authors.forename: Franck
authors.initials: F
authors.lastname: Paganelli
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Price
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gurbel
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology* / Q000627:therapeutic use; D015906:Angioplasty, Balloon, Coronary; D001792:Blood Platelets / Q000187:drug effects*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D010979:Platelet Function Tests / Q000379:methods; D058919:Purinergic P2 Receptor Antagonists; D012372:ROC Curve; D012307:Risk Factors; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D058919:Purinergic P2 Receptor Antagonists; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine