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Thromb Haemost 2015; 113(01): 37-52
DOI: 10.1160/TH14-03-0238
Review Article
Schattauer GmbH

How to improve the concept of individualised antiplatelet therapy with P2Y12 receptor inhibitors – is an algorithm the answer?

Jolanta M. Siller-Matula
1   Department of Cardiology, Medical University of Vienna, Austria
,
Dietmar Trenk
2   Clinics of Cardiology and Angiology II, Universitaets-Herzzentrum Freiburg · Bad Krozingen, Bad Krozingen, Germany
,
Karsten Schrör
3   Institut für Pharmakologie und Klinische Pharmakologie, Heinrich-Heine-Universität, Düsseldorf, Germany
,
Meinrad Gawaz
4   Medizinische Klinik III, Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
,
Steen D. Kristensen
5   Department of Cardiology, Aarhus University Hospital, Denmark
,
Robert F. Storey
6   Department of Cardiovascular Science, University of Sheffield, UK
,
Kurt Huber
7   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
,
for the European Platelet Academy › Author Affiliations
Further Information

Publication History

Received: 16 March 2014

Accepted after major revision: 22 July 2014

Publication Date:
29 November 2017 (online)

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Summary

Within the past decade, high on-treatment platelet reactivity (HTPR) on clopidogrel and its clinical implications have been frequently discussed. Although it has been previously assumed that HTPR is a phenomenon occurring only in patients treated with clopidogrel, recent data show that HTPR might also occur during treatment with prasugrel or ticagrelor in the acute phase of ST-elevation myocardial infarction. Moreover, it has been postulated that there is a therapeutic window for P2Y12 receptor blockers, thus indicating that HTPR is associated with thrombotic events whereas low on-treatment platelet reactivity (LTPR) is associated with bleeding events. The current paper focuses on tools to identify risk factors for HTPR (pharmacogenomic testing, clinical scoring and drug-drug interactions) and on the use of platelet function testing in order to identify patients who might not respond adequately to clopidogrel. The majority of recent clinical randomised trials have not supported the hypothesis that platelet function testing and tailored antiplatelet therapy are providing a favourable clinical outcome. These trials, mainly performed in low-to-moderate risk patients, will be reviewed and discussed. Finally, an algorithm based on current knowledge is suggested, which might be of use for design of clinical trials.

Keywords

Platelet reactivity - clopidogrel - prasugrel - ticagrelor
 

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