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Updated: Aug 22, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Platelet function testing in atrial fibrillation patients undergoing percutaneous coronary intervention
Ioannis Lianos1, Charalampos Varlamos1, Despoina-Rafailia Benetou1
12nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Rimini 1, Chaidari, 12462, Athens, Greece.
Insights
Platelet function testing (PFT) in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) showed ticagrelor led to lower platelet reactivity than clopidogrel. PFT results did not impact treatment decisions or predict bleeding events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) require antithrombotic therapy.
- Individualized treatment guided by platelet function testing (PFT) is a potential strategy.
- Real-world data on PFT in this population are limited.
Purpose of the Study:
- To investigate platelet reactivity (PR) in AF patients on oral anticoagulants (OAC) undergoing PCI.
- To compare PR between clopidogrel and ticagrelor.
- To assess the impact of PFT on clinical decisions and outcomes.
Main Methods:
- Retrospective analysis of a nationwide, multicenter observational study.
- Included AF patients on OAC undergoing PCI, treated with clopidogrel or ticagrelor.
- Performed PFT before discharge and followed patients for 12 months.
Main Results:
- Ticagrelor resulted in significantly lower PR (46.02 PRU) compared to clopidogrel (162.9 PRU).
- High on-treatment PR (HTPR) was more common with clopidogrel (22.7%) than ticagrelor.
- Low on-treatment PR (LTPR) was more frequent with ticagrelor (80%) than clopidogrel (13.6%).
- PFT results did not influence aspirin prescription or predict bleeding events.
- Physician response to PFT results was variable.
Conclusions:
- Ticagrelor demonstrates superior platelet inhibition compared to clopidogrel in AF patients undergoing PCI.
- Current PFT protocols may not effectively guide antithrombotic therapy or predict outcomes in this patient group.
- Further research is needed to establish the clinical utility of PFT for personalized antithrombotic management.
Abstract:
Platelet function testing (PFT) could be a useful clinical tool to guide individualized antithrombotic treatment in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). We aimed to investigate platelet reactivity (PR) in the context of a contemporary registry. "Real-world" data were retrieved from a nationwide, multicenter, observational study of AF patients on oral anticoagulants (OAC) undergoing PCI. Patients treated with a P2Y12 inhibitor, namely clopidogrel or ticagrelor, as part of double or triple antithrombotic therapy, were submitted to PFT before discharge and were followed up for 12 months. Out of 101 patients included in the study, 66 were submitted to PFT while on clopidogrel and 35 while on ticagrelor; PR was 162.9 ± 68 PRU and 46.02 ± 46 PRU, respectively (P < 0.001). High on-treatment PR (HTPR) was observed in 15 patients under clopidogrel (22.7%); 7 of them escalated to ticagrelor. Low on-treatment PR (LTPR) was found in 9 clopidogrel and 28 ticagrelor-treated patients (13.6% vs. 80%, P < 0.001), of whom only 1 de-escalated to clopidogrel. PR did not differ by OAC regimen. PFT results had no impact on aspirin prescription at discharge, while failed to predict significant bleeding events at follow up. Ticagrelor administration led to lower PR and lower incidence of HTPR in comparison with clopidogrel. Physicians' behavior in response to knowledge of a patient's PR was variable. Further studies are required to elucidate the role of PFT as a tool to guide individualized antithrombotic treatment in this clinical scenario.
