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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Assessing platelet reactivity after drug eluting stent implantation: state of the art
Udaya S Tantry1, Saroj Timilsina1, Amit Rout1
1Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA.
Insights
Platelet function testing guides dual antiplatelet therapy (DAPT) in drug-eluting stent patients, reducing bleeding risks without increasing ischemic events. This approach optimizes treatment by avoiding overuse of potent P2Y12 inhibitors.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis
Background:
- Platelets are crucial in recurrent ischemic events for coronary artery disease patients on dual antiplatelet therapy (DAPT) with drug-eluting stents (DES).
- High platelet reactivity (HPR) to adenosine diphosphate during clopidogrel therapy predicts post-stenting ischemic events.
- Potent P2Y12 inhibitors reduce HPR but increase bleeding risk.
Purpose of the Study:
- To review the role of platelet function testing (PFT) in guiding DAPT for patients treated with DES.
- To evaluate the impact of PFT on ischemic and bleeding events in this patient population.
Main Methods:
- Literature search of electronic databases from January 2000 to December 2019.
- Focus on studies evaluating platelet function assessment after DES implantation.
- Analysis of selective P2Y12 inhibitor de-escalation strategies based on PFT.
Main Results:
- Selective P2Y12 inhibitor de-escalation guided by PFT shows similar ischemic event rates but reduced bleeding risk.
- Platelet function-guided therapy improves patient outcomes by reducing bleeding complications.
- Optimizing P2Y12 inhibitor use lessens bleeding and avoids overuse of potent agents.
Conclusions:
- Platelet function testing is valuable in tailoring DAPT for DES patients.
- De-escalation of P2Y12 inhibitors based on PFT can improve safety profiles.
- Future focus on de-escalation will increase as bleeding consequences and healthcare costs are better understood.
Abstract:
Introduction: Platelets play a pivotal role in the occurrence of recurrent ischemic events in coronary artery disease patients who are treated with drug-eluting stents and are on dual antiplatelet therapy (DAPT).Areas covered: High platelet reactivity (HPR) to adenosine diphosphate during clopidogrel therapy is a strong predictor of post-stenting ischemic event occurrences. However, uniform use of potent P2Y12 receptors blockers to overcome HPR is associated with elevated bleeding risk. Selective de-escalation of P2Y12 receptor blocker therapy based on PFT in patients with acute coronary syndrome treated with stenting has been shown to be associated with a similar risk of ischemic event occurrence but with a reduced risk of bleeding. This review aims to discuss the role of PFT in guiding DAPT in patients treated with DES. We searched electronic databases from January 2000 to December 2019 for literatures evaluating the role of platelet function assessment after drug eluting stents.Expert opinion: Platelet function guided therapy improves patient outcomes by lessening bleeding and limiting the overuse of highly potent P2Y12 inhibitors. Interest in this area of de-escalation of therapy will likely grow as the consequences of bleeding are better recognized and the cost of healthcare gains greater focus.
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