Peri-procedural platelet function testing in risk stratification and clinical decision making
Myocardial infarction (MI) and stent thrombosis are catastrophic events that occur in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). The clinical efficacy of dual antiplatelet therapy (DAPT) of aspirin and a P2Y12 receptor blocker in preventing MI and stent thrombosis has been demonstrated in a wide range of high risk CAD patients. The understanding of platelet receptor physiology has markedly improved, more potent P2Y12 receptor blockers which can overcome some of the limitations of clopidogrel have been developed, and cheaper generic clopidogrel is available. In the TRIGGER-PCI trial, the effects of a more potent active arm compared with standard dose clopidogrel in low risk patients with HPR undergoing non-urgent PCI was investigated. In patients undergoing coronary artery bypass grafting (CABG), withdrawal of a P2Y12 receptor blocker treatment for 5-7 days is recommended by the guidelines to avoid excessive peri-operative bleeding by allowing platelet function recovery.
