Selecting optimal antiplatelet therapy based on platelet function monitoring in patients with coronary artery disease

Paul A. Gurbel, Udaya S. Tantry

Research output: Contribution to journalReview articlepeer-review


Results from pharmacodynamic and translational research studies assessing platelet reactivity have highlighted the limitations of current oral antiplatelet therapy. The data from translational research studies present strong arguments against the "one-size-fits-all" approach that has been used in large-scale clinical trials. At one end of the spectrum, selected patients with excessively low on-treatment platelet reactivity may have unnecessary bleeding, whereas patients with high platelet reactivity may experience ischemic events. Current evidence suggests that high on-treatment platelet reactivity will become a major risk factor determined as standard of care in patients with cardiovascular diseases. Future translational research holds the promise of identifying a therapeutic window for antiplatelet therapy based on objective measurement of platelet physiology. The main aim of this therapeutic window is to effectively attenuate ischemic events while avoiding bleeding risk with excessive platelet inhibition in selected patients with optimal antiplatelet therapeutic strategies involving current or novel antiplatelet agents. Preliminary findings suggest there may be thresholds predictive of adverse ischemic events. Ongoing studies such as GRAVITAS (Gauging Responsiveness With a Verify Now Assay-Impact on Thrombosis and Safety) and the S.T.E.N.T. Thrombosis Study and future research will likely support the current concepts and lead to personalized treatment regimens that will optimize antiplatelet therapy.

Original languageEnglish (US)
Pages (from-to)22-32
Number of pages11
JournalCurrent Treatment Options in Cardiovascular Medicine
Issue number1
StatePublished - 2009
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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