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. 2008 Mar 26;31(Suppl 1):I10–I16. doi: 10.1002/clc.20361

Assessing the Current Role of Platelet Function Testing

Eugene Braunwald 1,, Dominick Angiolillo 2, Eric Bates 3, Peter B Berger 4, Deepak Bhatt 5, Christopher P Cannon 1, Mark I Furman 6, Paul Gurbel 7, Alan D Michelson 8, Eric Peterson 9, Stephen Wiviott 1
PMCID: PMC6653601  PMID: 18481816

Abstract

In vitro platelet function tests are commonly applied in research and offer justification for using antiplatelet therapy. However, studies assessing the ability of standardized platelet function tests to predict patients' clinical response to aspirin or clopidogrel have generated contradictory results. At this time, there is no standardized definition for resistance to antiplatelet therapy, and the appropriate treatment of patients who are hyporesponsive to these agents is not known. Although such tests have a role in research, their place in guiding therapy remains to be established, and prospective trials are urgently needed. The ideal platelet function test for clinical practice would be rapid, easy‐to‐use, inexpensive, and reliable. Copyright © 2008 Wiley Periodicals, Inc.

Keywords: catheterization/diagnostic interventional <cardiac, acute coronary syndromes <ischemic heart disease, platelets, thrombosis/hypercoagulable states

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References

  • 1. Michelson AD: Evaluation of platelet function by flow cytometry. Pathophysiol Haemost Thromb 2006; 35: 67–82. [DOI] [PubMed] [Google Scholar]
  • 2. Gurbel PA, Becker RC, Mann KG, Steinhubl SR, Michelson AD: Platelet function monitoring in patients with coronary artery disease. J Am Coll Cardiol 2007; 50: 1822–1834. [DOI] [PubMed] [Google Scholar]
  • 3. Michelson AD: Platelet function testing in cardiovascular diseases. Circulation 2004; 110: e489–e493. [DOI] [PubMed] [Google Scholar]
  • 4. Michelson AD, Frelinger AL III, Furman MI: Current options in platelet function testing. Am J Cardiol 2006; 98: S4–S10. [DOI] [PubMed] [Google Scholar]
  • 5. Harrison P, Keeling D: Clinical tests of platelet function In: Michelson AD, ed. Platelets. 2nd ed. Elsevier, Inc./Academic Press; San Diego, CA: 2007; 445–474. [Google Scholar]
  • 6. Michelson AD, Frelinger AL III, Furman MI: Current options in platelet function testing. Am J Cardiol 2006; 98(10A): 4N–10N. [DOI] [PubMed] [Google Scholar]
  • 7. Michelson AD, Linden MD, Furman MI, Li Y, Barnard MR, et al.: Evidence that pre‐existent variability in platelet response to ADP accounts for 'clopidogrel resistance. J Thromb Haemost 2007; 5: 75–81. [DOI] [PubMed] [Google Scholar]
  • 8. Eikelboom JW, Hirsh J, Weitz JI, Johnston M, Yi Q, et al.: Aspirin‐resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events. Circulation 2002; 105: 1650–1655. [DOI] [PubMed] [Google Scholar]
  • 9. Gum PA, Kottke‐Marchant K, Welsh PA, White J, Topol EJ: A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol 2003; 41: 961–965. [DOI] [PubMed] [Google Scholar]
  • 10. Gum PA, Kottke‐Marchant K, Poggio ED, Gurm H, Welsh PA, et al.: Profile and prevalence of aspirin resistance in patients with cardiovascular disease. Am J Cardiol 2001; 88: 230–235. [DOI] [PubMed] [Google Scholar]
  • 11. Ohmori T, Yatomi Y, Nonaka T, Kobayashi Y, Madoiwa S, et al.: Aspirin resistance detected with aggregometry cannot be explained by cyclooxygenase activity: involvement of other signaling pathway(s) in cardiovascular events of aspirin‐treated patients. J Thromb Haemost 2006; 4: 1271–1278. [DOI] [PubMed] [Google Scholar]
  • 12. Chen WH, Lee PY, Ng W, Tse HF, Lau CP, et al.: Aspirin resistance is associated with a high incidence of myonecrosis after non‐urgent percutaneous coronary intervention despite clopidogrel pretreatment. J Am Coll Cardiol 2004; 43: 1122–1126. [DOI] [PubMed] [Google Scholar]
  • 13. Matetzky S, Shenkman B, Guetta V, Shechter M, Bienart R, et al.: Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation 2004; 109: 3171–3175. [DOI] [PubMed] [Google Scholar]
  • 14. Gurbel PA, Bliden KP, Samara W, Yoho JA, Hayes K, et al.: Clopidogrel effect on platelet reactivity in patients with stent thrombosis: results of the CREST study. J Am Coll Cardiol 2005; 46: 1827–1832. [DOI] [PubMed] [Google Scholar]
  • 15. Barragan P, Bouvier JL, Roquebert PO, Macaluso G, Commeau P, et al.: Resistance to thienopyridines: clinical detection of coronary stent thrombosis by monitoring of vasodilator‐stimulated phosphoprotein phosphorylation. Catheter Cardiovasc Interv 2003; 59: 295–302. [DOI] [PubMed] [Google Scholar]
  • 16. Ajzenberg N, Aubry P, Huisse MG, Cachier A, El Amara W, et al.: Enhanced shear‐induced platelet aggregation in patients who experience subacute stent thrombosis: a case‐control study. J Am Coll Cardiol 2005; 45: 1753–1756. [DOI] [PubMed] [Google Scholar]
  • 17. Wenaweser P, Dorffler‐Melly J, Imboden K, Windecker S, Togni M, et al.: Stent thrombosis is associated with an impaired response to antiplatelet therapy. J Am Coll Cardiol 2005; 45: 1748–1752. [DOI] [PubMed] [Google Scholar]
  • 18. Task Force on the Use of Antiplatelet Agents in Patients with Atherosclerotic Cardiovascular Disease of the European Society of Cardiology : Expert consensus document on the use of antiplatelet agents. Eur Heart J 2004; 25: 166–181. [DOI] [PubMed] [Google Scholar]
  • 19. Michelson AD, Cattaneo M, Eikelboom JW, Gurbel P, Kottke‐Marchant K, et al, For the Platelet Physiology Subcommittee of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis; Working Group on Aspirin Resistance : Aspirin resistance: position paper of the Working Group on Aspirin Resistance. J Thromb Haemost 2005; 3: 1309–1311. [DOI] [PubMed] [Google Scholar]
  • 20. American College of Cardiology/American Heart Association Task Force on Practice Guidelines : ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention. Circulation 2006; 113: e1–e121. [DOI] [PubMed] [Google Scholar]
  • 21. Gurbel PA: The relationship of platelet reactivity to the occurrence of post‐stenting ischemic events: emergence of a new cardiovasclar risk factor. Rev Cardiovasc Med 2007; 7: S20–S28. [PubMed] [Google Scholar]
  • 22. Gurbel PA, Becker RC, Mann KG, Steinhubl SR, Michelson AD: Platelet function moniroting in patients with coronary artery disease. J Am Coll Cardiol 2007; 50: 1822–1834. [DOI] [PubMed] [Google Scholar]
  • 23. Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, et al.: Incidence, predictors, and outcome of thrombosis after successful implantation of drug‐eluting stents. JAMA 2005; 293: 2126–2130. [DOI] [PubMed] [Google Scholar]
  • 24. McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, et al.: Late thrombosis in drug‐eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004; 364: 1519–1521. [DOI] [PubMed] [Google Scholar]
  • 25. Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, et al.: Pathology of drug‐eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 2006; 48: 193–202. [DOI] [PubMed] [Google Scholar]

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