Antiplatelet drugs in patients with enhanced platelet turnover: biomarkers versus platelet function testing.
Platelets are key players in atherothrombosis. Antiplatelet therapy comprising aspirin alone or with P2Y12-inhibitors are effective for prevention of atherothrombotic complications. However, there is interindividual variability in the response to antiplatelet drugs, leaving some patients at increased risk of recurrent atherothrombotic events. Several risk factors associated with high on-treatment platelet reactivity (HTPR), including elevated platelet turnover, have been identified. Platelet turnover is adequately estimated from the fraction of reticulated platelets. Reticulated platelets are young platelets, characterised by residual messenger RNA. They are larger, haemostatically more active and there is evidence that platelet turnover is a causal and prognostic factor in atherothrombotic disease. Whether platelet turnover per se represents a key factor in pathogenesis, progression and prognosis of atherothrombotic diseases (with focus on acute coronary syndromes) or whether it merely facilitates insufficient platelet inhibition will be discussed in this state-of-the art review.
Matthias K. Freynhofer, MD, 3rd Department of Medicine, Cardiology, Wilhelminen Hospital, Montleartstraße 37, A-1160, Vienna, Austria, Tel.: +43 1 49150 2301, Fax: +43 1 49150 2309, E-mail: matthias.freynhofer@gmx.at.
Matthias K
MK
Freynhofer
Susanne C
SC
Gruber
Erik L
EL
Grove
Thomas W
TW
Weiss
Johann
J
Wojta
Kurt
K
Huber
D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007700:Kinetics; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects*; D034061:Thrombopoiesis / Q000187:drug effects*; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D015415:Biomarkers; C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12
P2Y12 inhibitors; Platelet turnover; aspirin; mean platelet volume; reticulated platelets