Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Bonello, L; Tantry, US; Marcucci, R; Blindt, R; Angiolillo, DJ; Becker, R; Bhatt, DL; Cattaneo, M; Collet, JP; Cuisset, T; Gachet, C; Montalescot, G; Jennings, LK; Kereiakes, D; Sibbing, D; Trenk, D; Van Werkum, JW; Paganelli, F; Price, MJ; Waksman, R; Gurbel, PA; Working Group on High On-Treatment Platelet Reactivity,

Published Date

  • September 14, 2010

Published In

Volume / Issue

  • 56 / 12

Start / End Page

  • 919 - 933

PubMed ID

  • 20828644

Pubmed Central ID

  • 20828644

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2010.04.047

Language

  • eng

Conference Location

  • United States