Advertisement
Advertisement
Advertisement

Clopidogrel response variability and the advent of personalised antiplatelet therapy

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
Platelet function testing: From bench to bedside

DOI: http://dx.doi.org/10.1160/TH11-03-0167
Issue: 2011: 106/2 (Aug) pp. 185-387
Pages: 265-271

Clopidogrel response variability and the advent of personalised antiplatelet therapy

A bench to bedside journey

P. A. Gurbel (1), U. S. Tantry (1)

(1) Sinai Center for Thrombosis Research, Baltimore, Maryland, USA

Summary

Platelet-mediated thrombosis is a dreaded clinical event and is the primary cause of acute coronary syndromes and post-percutaneous intervention (PCI) ischaemic events. There has been a long standing interest in the ex vivo quantification of platelet reactivity to assess the risk of thrombosis. Early studies demonstrated platelet activation and heightened platelet reactivity in acute coronary syndromes and after PCI. However, a demonstration that heightened reactivity actually precipitated the ischaemic event was lacking. Our knowledge of platelet receptor physiology and the advent of novel inhibitors have significantly advanced the field. The P2Y12 receptor has been shown to play a pivotal role in the amplification of platelet activation by multiple agonists and its inhibition has resulted in improved clinical outcomes. The most widely used drug to block P2Y12 receptor, clopidogrel is associated with resistance in selected patients and these patients have been shown to be at increased risk for post-PCI ischaemic event occurrence in multiple studies. Importantly, a threshold of high platelet reactivity has been demonstrated, and beyond this threshold ischaemic events occur precipitously. Based on the current evidence, it is rational to quantify the intensity of the ADP-P2Y12 interaction in the patient at the greatest risk for thrombosis-the PCI patient. However, there is only evidence from small clinical trials demonstrating the clinical efficacy of changing an antiplatelet regimen based on an ex vivo platelet function measurement. Moreover, there are numerous patients with vulnerable coronary anatomy that have not yet experienced plaque rupture; the prognostic role of a measurement of platelet reactivity in the latter group has never been studied. Large-scale trials are ongoing that will investigate the role of personalised antiplatelet therapy in the PCI patient.

Keywords

Clinical trials, antiplatelet drugs, atherothrombosis, ADP receptors

DOI

http://dx.doi.org/10.1160/TH11-03-0167

You may also be interested in...

1.

Andreas E. May, Tobias Geisler, Meinrad Gawaz

Thromb Haemost 2008 99 3: 487-493

http://dx.doi.org/10.1160/TH07-11-0680

2.

E. L. Grove (1), R. Hossain (2), R. F. Storey (2)

Thromb Haemost 2013 109 5: 817-824

http://dx.doi.org/10.1160/TH12-11-0806

3.

P. A. Gurbel (1), M. T. Roe (2), J. A. Jakubowski (3), S. Shah (2), D. Erlinge (4), S. G. Goodman (5), K. Huber (6), M. Y. Chan (7), J. H. Cornel (8), U. S. Tantry (1), E. M. Ohman (2)

Thromb Haemost 2012 108 1: 12-20

http://dx.doi.org/10.1160/TH12-01-0039



Thrombosis News

Mobile technology identifies people with unknown atrial fibrillation at high risk of stroke – article published in Thrombosis and Haemostasis

The article “Feasibility and cost effectiveness of stroke prevention through community screening...

TH 111.4

The April 2014 TH 111.4 issue of Thrombosis and Haemostasis is a Theme Issue by Guest Editor B....

TH 111.3

Women with atrial fibrillation have a much higher risk for thromboembolic stroke than men suffering...