Consensus and Update on the Definition of On-Treatment Platelet Reactivity to Adenosine Diphosphate Associated With Ischemia and Bleeding

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:62

Review

Tantry, Udaya S.¹  Bonello, Laurent²  Aradi, Daniel³  Price, Matthew J.^4,5  Jeong, Young-Hoon⁶  Angiolillo, Dominick J.⁷  Stone, Gregg W.⁸  Curzen, Nick⁹  Geisler, Tobias¹⁰  ten Berg, Jurrien¹¹  Kirtane, Ajay⁸  Siller-Matula, Jolanta¹²  Mahla, Elisabeth¹³  Becker, Richard C.¹⁴  Bhatt, Deepak L.¹⁵  Waksman, Ron¹⁶  Rao, Sunil V.¹⁷  Alexopoulos, Dimitrios¹⁸  Marcucci, Rossella¹⁹  Reny, Jean-Luc^20,21  Trenk, Dietmar²²  Sibbing, Dirk²³  Gurbel, Paul A.¹ 

[1] Sinai Hosp, Sinai Ctr Thrombosis Res, Baltimore, MD 21215 USA

[2] Aix Marseille Univ, Hop Univ Nord, Dept Cardiol, Marseille, France

[3] Heart Ctr Balatonfured, Dept Cardiol, Balatonfured, Hungary

[4] Scripps Clin, La Jolla, CA USA

[5] Scripps Translat Sci Inst, La Jolla, CA USA

[6] Gyeongsang Natl Univ, Dept Internal Med, Gyeongsang Natl Univ Hosp, Jinju, South Korea

[7] Univ Florida, Coll Med, Cardiovasc Res Ctr, Jacksonville, FL USA

[8] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA

[9] Southampton Natl Hlth Serv Fdn Trust, Univ Hosp, Wessex Cardiothorac Unit, Southampton, Hants, England

[10] Univ Klinikum Tubingen, Med Klin 3, Tubingen, Germany

[11] St Antonius Hosp, Dept Cardiol, Nieuwegein, Netherlands

[12] Med Univ Vienna, Dept Cardiol, Vienna, Austria

[13] Med Univ Graz, Dept Anesthesiol & Intens Care Med, Graz, Austria

[14] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA

[15] Harvard Univ, Brigham & Womens Hosp, Sch Med, Vet Affairs Boston Healthcare Syst, Boston, MA 02115 USA

[16] Medstar Washington Hosp Ctr, Washington, DC USA

[17] Duke Clin Res Inst, Durham, NC USA

[18] Patras Univ Hosp, Dept Cardiol, Patras, Greece

[19] Univ Florence, Dept Med & Surg Crit Care, Florence, Italy

[20] Univ Hosp Geneva, Dept Internal Med Rehabil & Geriatr, Geneva Platelet Grp, Geneva, Switzerland

[21] Univ Geneva, Sch Med, CH-1211 Geneva, Switzerland

[22] Univ Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany

[23] Univ Munich, Med Klin & Poliklin 1, Dept Cardiol, Munich, Germany

关键词: adenosine diphosphate;    bleeding;    consensus;    ischemia;    platelet reactivity.;   

DOI  :  10.1016/j.jacc.2013.07.101

来源: Elsevier

【 摘 要 】

Dual antiplatelet therapy with aspirin and a P2Y(12) receptor blocker is a key strategy to reduce platelet reactivity and to prevent thrombotic events in patients treated with percutaneous coronary intervention. In an earlier consensus document, we proposed cutoff values for high on-treatment platelet reactivity to adenosine diphosphate (ADP) associated with post-percutaneous coronary intervention ischemic events for various platelet function tests (PFTs). Updated American and European practice guidelines have issued a Class IIb recommendation for PFT to facilitate the choice of P2Y(12) receptor inhibitor in selected high-risk patients treated with percutaneous coronary intervention, although routine testing is not recommended (Class III). Accumulated data from large studies underscore the importance of high on-treatment platelet reactivity to ADP as a prognostic risk factor. Recent prospective randomized trials of PFT did not demonstrate clinical benefit, thus questioning whether treatment modification based on the results of current PFT platforms can actually influence outcomes. However, there are major limitations associated with these randomized trials. In addition, recent data suggest that low on-treatment platelet reactivity to ADP is associated with a higher risk of bleeding. Therefore, a therapeutic window concept has been proposed for P2Y(12) inhibitor therapy. In this updated consensus document, we review the available evidence addressing the relation of platelet reactivity to thrombotic and bleeding events. In addition, we propose cutoff values for high and low on-treatment platelet reactivity to ADP that might be used in future investigations of personalized antiplatelet therapy. (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

Free