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Volume 12, Supplement 1 - 2011

Volume 12, Supplement 1 - 2011

Table of Contents

The Brave New World of Antiplatelet Therapy: Seeking Clarity in a World of Increasing Choice and Complexity Integrating Platelet Function Testing Into Clinical Practice
[Rev Cardiovasc Med. 2011;12(suppl 1):S1-S3 doi: 10.3909/ricm12S1S0006] © 2011 MedReviews®, LLC
Current Options in Oral Antiplatelet Strategies During Percutaneous Coronary Interventions Integrating Platelet Function Testing Into Clinical Practice
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor blocker is the standard of care to prevent recurrent ischemic event occurrence in patients undergoing percutaneous intervention. Glycoprotein IIb/IIIa receptor inhibitors are used in addition to DAPT in the highest-risk clinical settings. The persistent occurrence of ischemic events in the presence of DAPT and the irrefutable demonstration of clopidogrel response variability are two potent arguments against the widely practiced nonselective or “one-size-fits-all” strategy of administering clopidogrel therapy and provides a strong rationale for monitoring clopidogrel therapy. New, potent P2Y12 inhibitors such as prasugrel and ticagrelor are associated with greater platelet inhibition, faster onset of action, and better overall clinical outcomes compared with clopidogrel, but are associated with more non–surgery-related bleeding than clopidogrel. The inhibition of the platelet thrombin receptor may provide additional benefits in attenuating ischemic event occurrence in selected high-risk patients treated with DAPT. [Rev Cardiovasc Med. 2011;12(suppl 1):S4-S13 doi: 10.3909/ricm12S1S0002] © 2011 MedReviews®, LLC
Latest Clinical Data on Testing for High On-Treatment Platelet Reactivity Integrating Platelet Function Testing Into Clinical Practice
Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndromes and in those who are undergoing percutaneous coronary intervention (PCI). Clopidogrel, a second-generation thienopyridine antiplatelet agent, is currently used to prevent vascular complications in atherothrombotic patients, to prevent stent thrombosis in patients undergoing PCI, and in the long-term prevention of cardiovascular and cerebrovascular events. Unfortunately, despite treatment with clopidogrel, some patients continue to have cardiovascular events. This may be due in part to a suboptimal response to the drug, with minimal inhibition of platelet aggregation and/or high on-treatment platelet reactivity. Point-of-care testing of clopidogrel response, together with a reliable diagnostic cutoff, can identify patients with high on-treatment platelet reactivity and optimize their clinical management. This article reviews the impact of poor clopidogrel responsiveness on clinical outcomes, the major clinical studies using VerifyNow P2Y12 Assay® (Accumetrics, San Diego, CA) to assess on-clopidogrel platelet reactivity, and efforts to determine a reliable cutoff. [Rev Cardiovasc Med. 2011;12(suppl 1):S14-S22 doi:10.3909/ricm12S1S0001] © 2011 MedReviews®, LLC
Optimizing Antiplatelet Therapy Following Percutaneous Coronary Intervention: Clinical Pathways for Platelet Function Testing Integrating Platelet Function Testing Into Clinical Practice
Current guidelines recommend dual antiplatelet therapy (DAPT), which includes aspirin and a platelet P2Y12 adenosine diphosphate (ADP) receptor antagonist, for treatment of patients with acute coronary syndrome and following percutaneous coronary intervention (PCI). Although DAPT significantly reduces stent thrombosis and major adverse cardiovascular events (MACE), there is considerable interindividual variability in the degree of platelet inhibition achieved with the most widely used ADP receptor antagonist, clopidogrel, and high on-treatment platelet activity in the setting of clopidogrel therapy (hyporesponsiveness) is associated with increased adverse cardiovascular events following PCI. Personalized tailoring of antiplatelet therapy guided by patient management algorithms and/or platelet function testing has the potential to reduce MACE and stent thrombosis. This article outlines specific algorithms for using potent new antiplatelet agents, such as prasugrel and ticagrelor, and platelet function “test and treat-to-target” strategies to reduce adverse cardiovascular events following PCI. [Rev Cardiovasc Med. 2011;12(suppl 1):S23-S33 doi: 10.3909/ricm12S1S0003] © 2011 MedReviews®, LLC
Platelet Function Testing in Practice: A Case Study Integrating Platelet Function Testing Into Clinical Practice
Dual antiplatelet therapy with aspirin and a thienopyridine reduces ischemic cardiovascular events following percutaneous coronary intervention. However, despite this treatment, residual risk of ischemic events persists. Among other factors, enhanced platelet reactivity after thienopyridine therapy is associated with an increased risk of ischemic cardiovascular events. A heterogeneous and variable patient response to the thienopyridine clopidogrel exists and has been attributed to a number of genetic, pharmacologic, and clinical factors. Developments in point-of-care platelet function testing allow for the assessment of on-treatment platelet reactivity after thienopyridine therapy and thus identify poor responders. We report two cases of stent thrombosis in which the bedside rapid platelet function VerifyNow P2Y12 Assay® (Accumetrics, San Diego, CA) was used to determine on-treatment platelet reactivity and identify potential etiologies of the thrombotic events. [Rev Cardiovasc Med. 2011;12(suppl 1):S34-S39 doi: 10.3909/ricm12S1S0004] © 2011 MedReviews®, LLC
Antiplatelet Therapy, Cardiac Surgery, and the Risk of Bleeding: The Surgeon’s Perspective Integrating Platelet Function Testing Into Clinical Practice
Antiplatelet therapy is widely accepted in the contemporary management of patients with coronary syndromes. Effective platelet inhibition can cause an increased risk of bleeding, which is more evident when patients are referred to surgical coronary revascularization. The cardiac surgeon should be familiar with all new antiplatelet drugs. In this article we compile the latest information about antiplatelet therapy and its impact on cardiac surgery. [Rev Cardiovasc Med. 2011;12(suppl 1):S40-S46 doi: 10.3909/ricm12S1S0005] © 2011 MedReviews®, LLC