Platelet Function Monitoring in Patients With Coronary Artery Disease

Gurbel, Paul A.; Becker, Richard C.; Mann, Kenneth G.; Steinhubl, Steven R.; Michelson, Alan D.

doi:10.1016/j.jacc.2007.07.051

Cited by 439 publications

(359 citation statements)

References 69 publications

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“…8 Through biotransformation, R-130964 irreversibly inhibits platelet aggregation. Although numerous epigenetic factors influence generation of the active metabolite and platelet-reactivity phenotype, [14][15][16] variation in the cytochrome P450 (CYP) allele, especially CYP2C19, has been shown to have the greatest influence. 8 The clinical importance of these factors has been the subject of much research and debate.…”

Section: Current P2y 12 Inhibitorsmentioning

confidence: 99%

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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| Guideline recommendations on the use of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention (PCI) have been formulated by both the ACC/AHA and the ESC. These recommendations are based primarily on large, phase III, randomized, controlled trials of the P2Y 12 inhibitors clopidogrel, prasugrel, and ticagrelor. However, few East Asian patients have been included in the trials to assess the use of these agents, particularly the newer agents prasugrel and ticagrelor. Additionally, an increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with white patients, and that a different 'therapeutic window' of on-treatment platelet reactivity might be appropriate in East Asian patients. Furthermore, a phenomenon referred to as the 'East Asian paradox' has been described, in which East Asian patients have a similar or even a lower rate of ischaemic events after PCI compared with white patients, despite a higher level of platelet reactivity during DAPT. Recognizing these concerns, the World Heart Federation has undertaken this evidence-based review and produced this expert consensus statement to determine the antiplatelet treatment strategies that are most appropriate for East Asian patients.

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Section: Current P2y 12 Inhibitorsmentioning

confidence: 99%

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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“…It performs dual measurements as internal control and abolishes disadvantages of the light transmission aggregometry (26,27). Like the VASP-P assay it has been found to be predictive for stent thrombosis and death after PCI and coronary stenting (9).…”

Section: Introductionmentioning

confidence: 99%

Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

Freynhofer¹,

Brozovic²,

Bruno³

et al. 2011

Thromb Haemost

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SummaryReduced antiplatelet effect of clopidogrel assessed with multiple electrode aggregometry (MEA) and vasodilator stimulated phosphoprotein-phosphorylation (VASP-P) assay has been proven to predict major adverse cardiovascular events (MACE) after coronary stenting. So far no consecutive registry has evaluated the usefulness of different adenosine diphosphate-based platelet function tests to predict outcome in unselected patients. Hence, our objective was to determine the feasibility of MEA and VASP-P for clinical routine and whether low-response to clopidogrel as determined by MEA and/or the VASP-P assays predicts MACE in a "real-life" population undergoing coronary stenting. Threehundred consecutive patients were included in this prospective registry. Blood was sampled 6-24 hours after stenting to measure MEA and VASP-P. The use of glycoprotein-IIb/IIIa-blockers limited MEA to 196 measurements. Concerning the VASP-P assay, 300 measurements were achieved. Receiver Operating Characteristics (ROC)-curves of sensitiv- ity and specificity estimates for MACE were plotted for VASP-P assay. The area under the ROC-curve was 0.683 (p=0.014) for the platelet reactivity index (PRI) calculated from median fluorescence intensities (FI) with an optimal cut-off at 60.2% PRI. Patients above 60.2% had a significantly increased risk for MACE at six months follow-up (p=0.007). Estimating the cut-offs for the PRI from mean FI (52%) or from geometric mean FI (56.6%) led to clinically relevant differences. VASP-P assay is feasible for clinical routine to measure clopidogrel effects and to predict post-procedural MACE in unselected patients. With regard to differing cut-offs, exact standardisation of the VASP-P assay is mandatory. The use of GP-IIb/IIIa-blockers prevents MEA testing and limits its usability in unselected patients.

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“…Although several risk stratification scores are available to assess the risk of recurrent ischemic events in ACS patients, such as GRACE (Global Registry of Acute Coronary Events), PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) and TIMI scores, none of these were used to identify and target those patients with ACS who were truly at high risk. Platelet function tests can also identify patients on clopidogrel at increased risk of MI, stent thrombosis, and cardiovascular death 34, 35. However, altering pharmacotherapy based on the results of platelet‐function testing failed to reduce recurrent ischemic events in patients undergoing PCI, including for ACS,36, 37 and current guidelines do not support platelet‐function testing 15, 38.…”

Section: Discussionmentioning

confidence: 99%

More, More, More: Reducing Thrombosis in Acute Coronary Syndromes Beyond Dual Antiplatelet Therapy—Current Data and Future Directions

Spinthakis

Farag

Rocca

et al. 2018

JAHA

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Platelet Function Monitoring in Patients With Coronary Artery Disease

Cited by 439 publications

References 69 publications

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

More, More, More: Reducing Thrombosis in Acute Coronary Syndromes Beyond Dual Antiplatelet Therapy—Current Data and Future Directions

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