Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate.
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.
Bonello
Laurent
L
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.
Tantry
Udaya S
US
Marcucci
Rossella
R
Blindt
Ruediger
R
Angiolillo
Dominick J
DJ
Becker
Richard
R
Bhatt
Deepak L
DL
Cattaneo
Marco
M
Collet
Jean Philippe
JP
Cuisset
Thomas
T
Gachet
Christian
C
Montalescot
Gilles
G
Jennings
Lisa K
LK
Kereiakes
Dean
D
Sibbing
Dirk
D
Trenk
Dietmar
D
Van Werkum
Jochem W
JW
Paganelli
Franck
F
Price
Matthew J
MJ
Waksman
Ron
R
Gurbel
Paul A
PA
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
D010975:Platelet Aggregation Inhibitors; D058919:Purinergic P2 Receptor Antagonists; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine