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      Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate.

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          Abstract

          The addition of clopidogrel to aspirin treatment reduces ischemic events in a wide range of patients with cardiovascular disease. However, recurrent ischemic event occurrence during dual antiplatelet therapy, including stent thrombosis, remains a major concern. Platelet function measurements during clopidogrel treatment demonstrated a variable and overall modest level of P2Y(12) inhibition. High on-treatment platelet reactivity to adenosine diphosphate (ADP) was observed in selected patients. Multiple studies have now demonstrated a clear association between high on-treatment platelet reactivity to ADP measured by multiple methods and adverse clinical event occurrence. However, the routine measurement of platelet reactivity has not been widely implemented and recommended in the guidelines. Reasons for the latter include: 1) a lack of consensus on the optimal method to quantify high on-treatment platelet reactivity and the cutoff value associated with clinical risk; and 2) limited data to support that alteration of therapy based on platelet function measurements actually improves outcomes. This review provides a consensus opinion on the definition of high on-treatment platelet reactivity to ADP based on various methods reported in the literature and proposes how this measurement may be used in the future care of patients.

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          Author and article information

          Journal
          J Am Coll Cardiol
          Journal of the American College of Cardiology
          Elsevier BV
          1558-3597
          0735-1097
          Sep 14 2010
          : 56
          : 12
          Affiliations
          [1 ] Department of Cardiology, Institut National de la Santè et de la Recherche Médicale Unité Mixte de Recherche 608, Hôpital Universitaire Nord, Faculté de Médecine, Marseille, France.
          Article
          S0735-1097(10)02473-3
          10.1016/j.jacc.2010.04.047
          20828644
          19f6dcd9-9224-4f54-b576-6bb8192546f3
          Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
          History

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