title: The role of perioperative antiplatelet therapy and platelet reactivity testing in carotid revascularization: overview of the evidence.
abstract: Antiplatelet therapy has reduced the incidence of thromboembolic events for patients undergoing carotid revascularization. However, the platelet inhibitory effect of aspirin and clopidogrel, the most commonly used P2Y12 receptor inhibitors, is variable among patients. Patients displaying high platelet reactivity despite aspirin or clopidogrel treatment are at higher risk for thromboembolic events during and after carotid revascularization. In order to reduce the incidence of high platelet reactivity, more potent P2Y12 receptor inhibitors as prasugrel are used. However, this strategy increases the risk of bleeding. As there is evidence of a therapeutic window for platelet inhibition, platelet function tests could be helpful for tailoring antiplatelet therapy based on the patient's thrombotic and bleeding risk. This evidence overview describes the most commonly used platelet inhibitors, platelet function tests and the current evidence for tailoring of antiplatelet therapy to patients undergoing carotid revascularization.
authors.affiliation: Department of Vascular Surgery,University Medical Centre Utrecht, Utrecht, The Netherlands - jurtenberg@gmail.com.
authors.forename: T C
authors.initials: TC
authors.lastname: Leunissen
authors.forename: G J
authors.initials: GJ
authors.lastname: De Borst
authors.forename: P W
authors.initials: PW
authors.lastname: Janssen
authors.forename: J M
authors.initials: JM
authors.lastname: ten Berg
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D016893:Carotid Stenosis / Q000097:blood / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects*; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12