Platelet function tests in clinical cardiology: unfulfilled expectations.

Area of Science:

• Cardiovascular Medicine
• Hematology
• Clinical Diagnostics

Background:

• Platelet function tests (PFTs) are crucial for assessing platelet activity in clinical cardiology.
• The ideal PFT should detect hyperreactivity, individualize antiplatelet therapy, and predict thrombotic and bleeding risks.
• Clinical cardiology requires rapid, accurate, and bedside-available PFTs.

Purpose of the Study:

• To critically evaluate the clinical utility of PFTs over the past decade in cardiology.
• To assess the effectiveness of PFTs in diagnosis, risk prediction, and therapy monitoring.
• To identify limitations of current PFTs and suggest future directions.

Main Methods:

• Review of publications from the last 10 years on PFTs in clinical cardiology.
• Evaluation of widely used point-of-care PFTs like PFA-100 and VerifyNow.
• Analysis of PFTs' ability to meet ideal criteria for clinical application.

Main Results:

• Current PFTs cannot reliably detect platelet hyperreactivity or prothrombotic states.
• PFTs do not consistently allow individualization of antiplatelet therapy.
• The predictive power of PFTs for thrombotic events is variable and modest; they cannot reliably assess bleeding risk.

Conclusions:

• Despite a decade of use, PFTs have not met the hopes for clinical practice in cardiology.
• A critical reappraisal of available PFT techniques is needed to align with clinical requirements.
• Future PFT development should consider native blood, global stimuli, thrombin generation, and drug-specific therapeutic ranges.