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Updated: May 15, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Towards personalized medicine based on platelet function testing for stent thrombosis patients
Thea Cornelia Godschalk1, Christian Marcus Hackeng, Jurriën Maria Ten Berg
1St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.
Insights
Personalized antiplatelet therapy (APT) guided by platelet function testing may optimize treatment for stent thrombosis (ST) patients. This approach aims to reduce high on-treatment platelet reactivity (HPR) and prevent recurrent cardiovascular events.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Stent thrombosis (ST) is a serious complication of coronary stenting.
- Standard antiplatelet therapy (APT) with aspirin and clopidogrel often results in high on-treatment platelet reactivity (HPR) in ST patients.
- HPR is a significant risk factor for recurrent atherothrombotic events in ST patients.
Purpose of the Study:
- To investigate the role of personalized antiplatelet therapy (APT) in managing stent thrombosis (ST) patients.
- To evaluate the effectiveness of platelet function testing in guiding APT strategies.
- To explore the transition from fixed to personalized APT for ST patients.
Main Methods:
- Utilizing platelet function testing to assess patient response to APT.
- Considering comedication, clinical characteristics, and genetics in treatment decisions.
- Implementing personalized APT strategies in an outpatient ST clinic setting.
Main Results:
- High on-treatment platelet reactivity (HPR) is prevalent in ST patients despite standard APT.
- Personalized APT strategies aim to optimize antiplatelet treatment based on individual patient responses.
- Ongoing research is crucial to define the optimal personalized APT strategy.
Conclusions:
- Personalized APT, guided by platelet function testing, offers a promising approach for ST patients.
- Tailoring APT based on individual factors like platelet reactivity, comedication, and genetics is essential.
- Further studies are needed to establish definitive personalized APT protocols to prevent atherothrombotic and bleeding events.
Abstract:
Stent thrombosis (ST) is a severe and feared complication of coronary stenting. Patients who have suffered from ST are usually treated according to the "one-size-fits-all" dosing regimen of aspirin and clopidogrel. Many ST patients show high on-treatment platelet reactivity (HPR) despite this antiplatelet therapy (APT). It has been shown that HPR is a risk factor for major adverse cardiac events. Therefore, ST patients with HPR are at a high risk for recurrent atherothrombotic events. New insights into the variable response to clopidogrel and the advent of stronger P2Y12 inhibitors prasugrel and ticagrelor have changed the attention from a fixed APT treatment strategy towards "personalized APT strategies." Strategies can be based on platelet function testing, which gives insight into the overall response of a patient to APT. At our outpatient ST clinic, we practice personalized APT based on platelet function testing to guide the cardiologist to a presumed optimal antiplatelet treatment of ST patients. Beside results of platelet function testing, comedication, clinical characteristics, and genetics have to be considered to decide on personalized APT. Ongoing studies have yet to reveal the optimal personalized APT strategy for cardiologists to prevent their patients from atherothrombotic and bleeding events.
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