Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate
L Bonello, US Tantry, R Marcucci, R Blindt… - Journal of the American …, 2010 - jacc.org
Journal of the American College of Cardiology, 2010•jacc.org
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 P2Y12inhibition. High on-treatment platelet reactivity to adenosine
diphosphate (ADP) was observed in selected patients. Multiple studies have now …
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 P2Y12inhibition. High on-treatment platelet reactivity to adenosine
diphosphate (ADP) was observed in selected patients. Multiple studies have now …
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 P2Y12inhibition. 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.
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