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Evolving role of platelet function testing in coronary artery interventions
The substantial reduction in ischemic events provided by the dual antiplatelet regimen with aspirin and clopidogrel is well documented in patients with acute coronary syndrome and patients undergoing percutaneous coronary intervention. Recently the variable response to the antiplatelet agents has re...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282607/ https://www.ncbi.nlm.nih.gov/pubmed/22371653 http://dx.doi.org/10.2147/VHRM.S28090 |
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author | Sharma, Rakesh K Voelker, Donald J Sharma, Rohit Reddy, Hanumanth K Dod, Harvinder Marsh, James D |
author_facet | Sharma, Rakesh K Voelker, Donald J Sharma, Rohit Reddy, Hanumanth K Dod, Harvinder Marsh, James D |
author_sort | Sharma, Rakesh K |
collection | PubMed |
description | The substantial reduction in ischemic events provided by the dual antiplatelet regimen with aspirin and clopidogrel is well documented in patients with acute coronary syndrome and patients undergoing percutaneous coronary intervention. Recently the variable response to the antiplatelet agents has received considerable attention after several “boxed warnings” on clopidogrel. This led to intense controversy on pharmacokinetic, pharmacodynamic, and pharmacogenomic issues of antiplatelet drugs, especially clopidogrel. Research use of platelet function testing has been successfully validated in identifying new antiplatelet drugs like prasugrel and ticagrelor. These platelet function assays are no longer regarded just as a laboratory phenomenon but rather as tools that have been shown to predict mortality in several clinical trials. It is believed that suboptimal response to an antiplatelet regimen (pharmacodynamic effect) may be associated with cardiovascular, cerebrovascular, and peripheral arterial events. There has been intense controversy about this variable response of antiplatelet drugs and the role of platelet function testing to guide antiplatelet therapy. While the importance of routine platelet function testing may be uncertain, it may be useful in high-risk patients such as those with diabetes mellitus, diffuse three vessels coronary artery disease, left main stenosis, diffuse atherosclerotic disease, and those with chronic renal failure undergoing percutaneous coronary intervention. It could also be useful in patients with suspected pharmacodynamic interaction with other drugs to assure the adequacy of platelet inhibition. While we wait for definitive trials, a predictive prognostic algorithm is necessary to individualize antiplatelet therapy with P2Y12 inhibitors based on platelet function assays and genetic testing. |
format | Online Article Text |
id | pubmed-3282607 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-32826072012-02-27 Evolving role of platelet function testing in coronary artery interventions Sharma, Rakesh K Voelker, Donald J Sharma, Rohit Reddy, Hanumanth K Dod, Harvinder Marsh, James D Vasc Health Risk Manag Review The substantial reduction in ischemic events provided by the dual antiplatelet regimen with aspirin and clopidogrel is well documented in patients with acute coronary syndrome and patients undergoing percutaneous coronary intervention. Recently the variable response to the antiplatelet agents has received considerable attention after several “boxed warnings” on clopidogrel. This led to intense controversy on pharmacokinetic, pharmacodynamic, and pharmacogenomic issues of antiplatelet drugs, especially clopidogrel. Research use of platelet function testing has been successfully validated in identifying new antiplatelet drugs like prasugrel and ticagrelor. These platelet function assays are no longer regarded just as a laboratory phenomenon but rather as tools that have been shown to predict mortality in several clinical trials. It is believed that suboptimal response to an antiplatelet regimen (pharmacodynamic effect) may be associated with cardiovascular, cerebrovascular, and peripheral arterial events. There has been intense controversy about this variable response of antiplatelet drugs and the role of platelet function testing to guide antiplatelet therapy. While the importance of routine platelet function testing may be uncertain, it may be useful in high-risk patients such as those with diabetes mellitus, diffuse three vessels coronary artery disease, left main stenosis, diffuse atherosclerotic disease, and those with chronic renal failure undergoing percutaneous coronary intervention. It could also be useful in patients with suspected pharmacodynamic interaction with other drugs to assure the adequacy of platelet inhibition. While we wait for definitive trials, a predictive prognostic algorithm is necessary to individualize antiplatelet therapy with P2Y12 inhibitors based on platelet function assays and genetic testing. Dove Medical Press 2012 2012-02-08 /pmc/articles/PMC3282607/ /pubmed/22371653 http://dx.doi.org/10.2147/VHRM.S28090 Text en © 2012 Sharma et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. |
spellingShingle | Review Sharma, Rakesh K Voelker, Donald J Sharma, Rohit Reddy, Hanumanth K Dod, Harvinder Marsh, James D Evolving role of platelet function testing in coronary artery interventions |
title | Evolving role of platelet function testing in coronary artery interventions |
title_full | Evolving role of platelet function testing in coronary artery interventions |
title_fullStr | Evolving role of platelet function testing in coronary artery interventions |
title_full_unstemmed | Evolving role of platelet function testing in coronary artery interventions |
title_short | Evolving role of platelet function testing in coronary artery interventions |
title_sort | evolving role of platelet function testing in coronary artery interventions |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282607/ https://www.ncbi.nlm.nih.gov/pubmed/22371653 http://dx.doi.org/10.2147/VHRM.S28090 |
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