Monitoring antiplatelet therapy during peripheral vascular and coronary interventions

Platelets play a central role in the initiation and propagation of thrombus formation. The use of antiplatelet and antithrombotic medications during peripheral vascular and coronary interventions helps reduce the likelihood of intravascular thrombus formation and adverse ischemic events. As formation of intravascular thrombus and subacute stent thrombosis are thrombin- and platelet-mediated phenomenon, achieving optimal activated clotting time and platelet inhibition (PI) during the interventional procedure is critical. However, as a quick and easy measure of platelet function has previously not been available in the interventional laboratory, cardiovascular interventions are routinely performed after administration of oral or intravenous antiplatelet agents without evaluating platelet function. Recently, point-of-care rapid platelet function assays have become available that allow quick and reproducible measure of platelet function in the interventional laboratory after administration of aspirin, thienopyridines, and glycoprotein IIb/IIIa inhibitors. Though PI can now be routinely measured during vascular interventions, considerable inconsistencies exist in the management of patients based on these results. We present an algorithm for the management of antiplatelet therapy during cardiovascular interventions based on rapid evaluation of platelet function in the interventional laboratory.