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Monitoring of Antiplatelet Therapy

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Platelets in Thrombotic and Non-Thrombotic Disorders

Abstract

The variability of response to antiplatelet agents and its potential relation to the occurrence of recurrent ischemic events have stimulated the concept of antiplatelet therapy monitoring over the last decade. This has been driven further by the development of user-friendly point-of-care methods to assess platelet reactivity to adenosine diphosphate. Large observational studies have established an independent relation between the results of point-of-care platelet function testing and adverse clinical outcomes, particularly in patients undergoing coronary artery stenting. Furthermore, the concept of a “therapeutic window” for P2Y12 receptor reactivity has been proposed, with an upper threshold associated with ischemic events and a lower threshold associated with bleeding. Prospective randomized trials have, however, failed to demonstrate that tailored antiplatelet therapy based on point-of-care assessment of platelet function is effective in reducing ischemic event occurrences. In the absence of robust prospective evidence to support a personalized approach, decisions regarding antiplatelet therapy rest on patient comorbidity, the large body of observational data, national and international guidelines, and recognition of the fundamental importance of platelet physiology in causing catastrophic events in those with high-risk coronary artery disease.

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Authors and Affiliations

  1. Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, 3600 Gallows Road, Fairfax, VA, 22042, USA

    Udaya S. Tantry & Paul A. Gurbel M.D.

  2. King’s College London BHF Centre of Research Excellence, The Rayne Institute, Cardiovascular Division, St. Thomas’ Hospital, London, UK

    Aung Myat

Authors
  1. Udaya S. Tantry
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  2. Aung Myat
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  3. Paul A. Gurbel M.D.
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Corresponding author

Correspondence to Paul A. Gurbel M.D. .

Editor information

Editors and Affiliations

  1. Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia , Perugia, Italy

    Paolo Gresele

  2. Houston Methodist Hospital , Houston, Texas, USA

    Neal S. Kleiman

  3. Bloodworks Northwest, University of Washington , Seattle, Washington, USA

    José A. Lopez

  4. Sackler Inst of Pulmonary Pharmacol, King’s College London, London, United Kingdom

    Clive P. Page

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Tantry, U.S., Myat, A., Gurbel, P.A. (2017). Monitoring of Antiplatelet Therapy. In: Gresele, P., Kleiman, N., Lopez, J., Page, C. (eds) Platelets in Thrombotic and Non-Thrombotic Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-47462-5_45

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