Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate

Laurent Bonello, Udaya S. Tantry, Rossella Marcucci, Ruediger Blindt, Dominick J. Angiolillo, Richard Becker, Deepak L. Bhatt, Marco Cattaneo, Jean Philippe Collet, Thomas Cuisset, Christian Gachet, Gilles Montalescot, Lisa K. Jennings, Dean Kereiakes, Dirk Sibbing, Dietmar Trenk, Jochem W. Van Werkum, Franck Paganelli, Matthew J. Price, Ron WaksmanPaul A. Gurbel

Research output: Contribution to journalArticlepeer-review

Abstract

The addition of clopidogrel to aspirin treatment reduces ischemic events in a wide range of patients with cardiovascular disease. However, recurrent ischemic event occurrence during dual antiplatelet therapy, including stent thrombosis, remains a major concern. Platelet function measurements during clopidogrel treatment demonstrated a variable and overall modest level of P2Y12 inhibition. High on-treatment platelet reactivity to adenosine diphosphate (ADP) was observed in selected patients. Multiple studies have now demonstrated a clear association between high on-treatment platelet reactivity to ADP measured by multiple methods and adverse clinical event occurrence. However, the routine measurement of platelet reactivity has not been widely implemented and recommended in the guidelines. Reasons for the latter include: 1) a lack of consensus on the optimal method to quantify high on-treatment platelet reactivity and the cutoff value associated with clinical risk; and 2) limited data to support that alteration of therapy based on platelet function measurements actually improves outcomes. This review provides a consensus opinion on the definition of high on-treatment platelet reactivity to ADP based on various methods reported in the literature and proposes how this measurement may be used in the future care of patients.

Original languageEnglish (US)
Pages (from-to)919-933
Number of pages15
JournalJournal of the American College of Cardiology
Volume56
Issue number12
DOIs
StatePublished - Sep 14 2010

Keywords

  • adenosine diphosphate
  • percutaneous coronary intervention
  • platelet reactivity
  • thrombotic events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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