title: Evolving role of platelet function testing in coronary artery interventions.
abstract: The substantial reduction in ischemic events provided by the dual antiplatelet regimen with aspirin and clopidogrel is well documented in patients with acute coronary syndrome and patients undergoing percutaneous coronary intervention. Recently the variable response to the antiplatelet agents has received considerable attention after several "boxed warnings" on clopidogrel. This led to intense controversy on pharmacokinetic, pharmacodynamic, and pharmacogenomic issues of antiplatelet drugs, especially clopidogrel. Research use of platelet function testing has been successfully validated in identifying new antiplatelet drugs like prasugrel and ticagrelor. These platelet function assays are no longer regarded just as a laboratory phenomenon but rather as tools that have been shown to predict mortality in several clinical trials. It is believed that suboptimal response to an antiplatelet regimen (pharmacodynamic effect) may be associated with cardiovascular, cerebrovascular, and peripheral arterial events. There has been intense controversy about this variable response of antiplatelet drugs and the role of platelet function testing to guide antiplatelet therapy. While the importance of routine platelet function testing may be uncertain, it may be useful in high-risk patients such as those with diabetes mellitus, diffuse three vessels coronary artery disease, left main stenosis, diffuse atherosclerotic disease, and those with chronic renal failure undergoing percutaneous coronary intervention. It could also be useful in patients with suspected pharmacodynamic interaction with other drugs to assure the adequacy of platelet inhibition. While we wait for definitive trials, a predictive prognostic algorithm is necessary to individualize antiplatelet therapy with P2Y12 inhibitors based on platelet function assays and genetic testing.
authors.affiliation: Medical Center of South Arkansas, Heart and Vascular Institute, 700 West Grove Street, El Dorado, AR 71730, USA. rsharma@uams.edu
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Sharma
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Voelker
authors.forename: Rohit
authors.initials: R
authors.lastname: Sharma
authors.forename: Hanumanth K
authors.initials: HK
authors.lastname: Reddy
authors.forename: Harvinder
authors.initials: H
authors.lastname: Dod
authors.forename: James D
authors.initials: JD
authors.lastname: Marsh
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy*; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D000818:Animals; D001792:Blood Platelets / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D003661:Decision Support Techniques; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists