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Assessment of oral antithrombotic therapy by platelet function testing

Nature Reviews Cardiology volume 8, pages 572–579 (2011)Cite this article

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Abstract

Dual antiplatelet therapy with clopidogrel and aspirin is recommended for the prevention of ischemic events in high-risk patients with coronary artery disease. In patients with atrial fibrillation, oral anticoagulant therapy with warfarin is the 'gold standard' for the prevention of thromboembolism. Nearly 20% of patients with atrial fibrillation also have coronary artery disease and receive combination therapy consisting of dual antiplatelet therapy plus warfarin, also known as triple antithrombotic therapy. Unfortunately, though, increased bleeding risk is a major concern during triple therapy. Whether platelet function testing can guide personalized antiplatelet therapy and reduce ischemic risk is under investigation in large trials of patients treated with coronary artery stents. However, limited data are available to establish the relationship between platelet function testing and bleeding in patients treated with dual or triple therapy. Personalized treatment strategies could help to achieve maximum clinical benefit while avoiding excessive bleeding complications. In this article, we review available data on the utility of platelet function testing in assessing bleeding risk and its potential role in personalizing combination antithrombotic therapies with the aim of reducing ischemic events and the frequency of bleeding.

Key Points

  • Anticoagulation therapy for patients with atrial fibrillation or acute coronary syndrome requires a balance between the prevention of stroke or recurrent coronary arterial thrombotic events and the avoidance of bleeding

  • Numerous platelet function tests exist that measure the response to antiplatelet therapy, including light transmittance aggregometry, the VerifyNow® assay, multiplatelet analyzer®, thromboelastography, or the platelet function analyzer-100®

  • The role of platelet function testing in guiding personalized antiplatelet therapy to reduce ischemic risk is being investigated

  • Data on the relationship between platelet function testing and bleeding in patients treated with dual or triple therapy are limited

  • A multifactorial approach that involves the assessment of demographic variables in addition to objective measurements of platelet function and coagulation might facilitate personalized therapy strategies

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Figure 1: Cumulative frequency distribution of P2Y12 reactivity measured by ADP-induced (20 μM) aggregation.

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Authors and Affiliations

  1. Sinai Center for Thrombosis Research, Siani Hospital, 2401 West Belvedere Avenue, Baltimore, 21215, MD, USA

    Udaya S. Tantry & Paul A. Gurbel

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  1. Udaya S. Tantry
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Both authors researched data and wrote the article, contributed substantially to the discussion of content, and reviewed and edited the manuscript before submission.

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Correspondence to Paul A. Gurbel.

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Competing interests

P. A. Gurbel is a consultant for Astra Zeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Lilly, Merck, Novartis, Portola, Pozen, and Sanofi-Aventis. He also recevied grant/research support from Astra Zeneca, Daiichi Sankyo, Portola, Pozen, and Sanofi-Aventis. U. S. Tantry declares no competing interests.

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Tantry, U., Gurbel, P. Assessment of oral antithrombotic therapy by platelet function testing. Nat Rev Cardiol 8, 572–579 (2011). https://doi.org/10.1038/nrcardio.2011.107

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