Is There a Role for Platelet Function Testing for Patients on Chronic Dual Antiplatelet Therapy?
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Is There a Role for Platelet Function Testing for Patients on Chronic Dual Antiplatelet Therapy? John Jason Sutton & Colin M. Barker
Published online: 30 June 2010 # Springer Science+Business Media, LLC 2010
Abstract Antiplatelet therapy is one on the cornerstones in managing patients with coronary artery disease who have undergone percutaneous interventions. Aspirin plus a thienopyridine (ticlopidine, clopidogrel, prasugrel) are the components of dual antiplatelet therapy (DAPT). Clopidogrel remains the primary thienopyridine in use. There is a significant amount of heterogeneity in patients’ response to the drug, both pharmacologically and clinically. It is apparent that those with high residual platelet reactivity on therapy are at an increased risk for future cardiovascular events. Therefore, platelet function testing makes sense and should be done routinely in patients on DAPT. These data provide physicians with an ability to adjust or change the antiplatelet therapy in response to the residual platelet reactivity. Options include increasing the dose of the present drug or changing to an alternative. The recent evidence regarding these data is reviewed in this article. Keywords Platelet function testing . Chronic dual antiplatelet therapy . DAPT
J. J. Sutton Department of Internal Medicine, University of Texas at Houston Medical School, 6341 Fannin Street, Houston, TX 77030, USA e-mail: [email protected] C. M. Barker (*) Division of Cardiology, Department of Internal Medicine, Memorial Hermann Hospital Heart and Vascular Institute at the Texas Medical Center, University of Texas at Houston, 6341 Fannin Street, MSB 1.246, Houston, TX 77030, USA e-mail: [email protected]
Introduction Currently, dual antiplatelet therapy (DAPT) is standard for any patient presenting with any acute coronary syndromes [1]. The usual combination of therapies is aspirin and a thienopyridine. The most common thienopyridine in use today is clopidogrel. Most clinicians are comfortable with these medications given their long history of use, relatively good safety profile, cost, availability, and personal experience. Over the past few years, however, there is growing evidence that this formulation is not a one-size-fits-all option [2, 3•]. The data are still evolving, but it appears that anywhere from 11% to 40% of the population is considered to have high residual platelet reactivity (HRPR) with standard treatment of 75 mg/d of clopidogrel. There are many possible etiologies cited for this variability and lack of predictable response. These include differences in absorption, metabolism, drug interactions, co-morbid diseases, loading dose, and duration of therapy. Clinicians are currently faced with many questions regarding platelet testing and subsequent treatment decisions. What test should be used? What standards should they to be held to? When should patients be tested? Once tested, what should be done with the results (ie, modify or change therapy)? Despite the availability of multiple assays designed to determine
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