Advances in platelet function testing assessing bleeding complications in patients with coronary artery disease

Antiplatelet therapy is the cornerstone of treatment in preventing ischemic events in patients with coronary artery disease (CAD), particularly in the setting of acute coronary syndromes and percutaneous coronary interventions. However, antiplatelet therapy is also associated with an increased risk of bleeding complications, which are more frequent with the use of more potent antiplatelet treatment regimens. Therefore, defining the balance between the risk of thrombotic events and the risk of bleeding is essential to improve overall clinical outcomes. The pharmcodynamic effects of antiplatelet agents vary broadly and may be associated with differences in outcomes. In particular, patients are at an increased risk of ischemic or bleeding complications if the pharmacodynamic effects are reduced or enhanced, respectively. Multiple platelet function assays are currently available to assess the pharmacodynamic effects of commonly used antiplatelet agents. The present manuscript will review the prognostic value of platelet function testing to identify patients with CAD at risk of bleeding complications and the potential applications of these tests in the modern era of antiplatelet pharmacotherapy.