Optimizing antiplatelet therapy following percutaneous coronary intervention: clinical pathways for platelet function testing

Abstract

Current guidelines recommend dual antiplatelet therapy (DAPT), which includes aspirin and a platelet P2Y(12) adenosine diphosphate (ADP) receptor antagonist, for treatment of patients with acute coronary syndrome and following percutaneous coronary intervention (PCI). Although DAPT significantly reduces stent thrombosis and major adverse cardiovascular events (MACE), there is considerable interindividual variability in the degree of platelet inhibition achieved with the most widely used ADP receptor antagonist, clopidogrel, and high on-treatment platelet activity in the setting of clopidogrel therapy (hyporesponsiveness) is associated with increased adverse cardiovascular events following PCI. Personalized tailoring of antiplatelet therapy guided by patient management algorithms and/or platelet function testing has the potential to reduce MACE and stent thrombosis. This article outlines specific algorithms for using potent new antiplatelet agents, such as prasugrel and ticagrelor, and platelet function "test and treat-to-target" strategies to reduce adverse cardiovascular events following PCI.