Title:New Insight in Antiplatelet Therapy Monitoring in Cardiovascular Patients: From Aspirin to Thienopyridine
VOLUME: 10 ISSUE: 3
Author(s):N. Hezard, A. Tessier-Marteau and L. Macchi
Affiliation:Laboratoire d'Hematologie, CHU Angers, France.
Keywords:Aspirin, clopidogrel, cardiovascular disease, platelet function tests.
Abstract:Antiplatelet therapy is used to reduce the risk of ischemic events in patients with cardiovascular disease. The
balance of benefits and risks of antiplatelet drugs in cardiovascular disease has been evaluated in large-scale randomised
trials, however the absolute benefit for an individual patient and a specific platelet-active drug needs further evaluation.
Several well-conducted studies have demonstrated a substantial inter-individual variability in platelet responsiveness to
drugs. The historical “gold standard” test of platelet function (optical aggregation) has been extensively used for measuring
the effect of antiplatelet drugs, but has limitations. New tests developed (i.e. PFA-100®, VerifyNow®) may overcome
some of these limitations but they do not correlate well with each other. Despite these unresolved methodological
questions, several recent clinical studies, but not all, suggest a significant correlation between antiplatelet resistance status
and serious vascular events. In these conditions, laboratory monitoring for antiplatelet therapies raises several questions:
(i) the necessity of a consensus regarding the definition of resistance and the relevant test, (ii) the demonstration that
biological resistance has clinical significance, and (iii) the clinical impact of individually adjusting the antiplatelet
therapy. Therefore, it is not currently appropriate to test patients or to change therapy on the basis of such tests, other than
in prospective and adequately powered clinical trials.
