On-treatment platelet reactivity: State of the art and perspectives

Area of Science:

• Cardiology
• Pharmacology
• Hematology

Background:

• High on-clopidogrel platelet reactivity (HcPR) is a significant risk factor for vascular events, including stent thrombosis, in acute coronary syndromes (ACS) patients.
• Factors like CYP2C19*2 polymorphism, age, female gender, diabetes, reduced ventricular function, inflammation, and increased platelet turnover are associated with HcPR.
• Newer antiplatelet agents, prasugrel and ticagrelor, have demonstrated superiority over clopidogrel in major clinical trials.

Purpose of the Study:

• To review the clinical significance of platelet reactivity during antiplatelet therapy in ACS.
• To discuss the limitations of clopidogrel and the advantages of newer agents.
• To highlight the emerging role of high on-aspirin platelet reactivity (HaPR) and the shift towards bleeding risk assessment.

Main Methods:

• Review of existing literature and clinical trial data on antiplatelet therapy in ACS.
• Analysis of factors influencing platelet reactivity and associated clinical outcomes.
• Discussion of current and future strategies for personalized antiplatelet therapy.

Main Results:

• HcPR is a validated marker for vascular risk in ACS.
• Prasugrel and ticagrelor offer improved efficacy compared to clopidogrel.
• Low on-treatment platelet reactivity (LPR) is linked to increased bleeding risk.

Conclusions:

• Platelet function testing is crucial for optimizing antiplatelet therapy in ACS.
• Personalized antiplatelet strategies, considering both thrombotic and bleeding risks, are essential for improved patient outcomes.
• Future management of ACS should integrate platelet function assessment alongside traditional risk factors.