Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding

Udaya S. Tantry, Laurent Bonello, Daniel Aradi, Matthew J. Price, Young Hoon Jeong, Dominick J. Angiolillo, Gregg W. Stone, Nick Curzen, Tobias Geisler, Jurrien Ten Berg, Ajay Kirtane, Jolanta Siller-Matula, Elisabeth Mahla, Richard C. Becker, Deepak L. Bhatt, Ron Waksman, Sunil V. Rao, Dimitrios Alexopoulos, Rossella Marcucci, Jean Luc RenyDietmar Trenk, Dirk Sibbing, Paul A. Gurbel

Research output: Contribution to journalReview article

602 Citations (Scopus)

Abstract

Dual antiplatelet therapy with aspirin and a P2Y12 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.

Original languageEnglish
Pages (from-to)2261-2273
Number of pages13
JournalJournal of the American College of Cardiology
Volume62
Issue number24
DOIs
Publication statusPublished - Dec 17 2013

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Keywords

  • adenosine diphosphate
  • bleeding
  • consensus
  • ischemia
  • platelet reactivity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Tantry, U. S., Bonello, L., Aradi, D., Price, M. J., Jeong, Y. H., Angiolillo, D. J., Stone, G. W., Curzen, N., Geisler, T., Ten Berg, J., Kirtane, A., Siller-Matula, J., Mahla, E., Becker, R. C., Bhatt, D. L., Waksman, R., Rao, S. V., Alexopoulos, D., Marcucci, R., ... Gurbel, P. A. (2013). 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, 62(24), 2261-2273. https://doi.org/10.1016/j.jacc.2013.07.101