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

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Citation: Journal of the American College of Cardiology. 62(24):2261-73, 2013 Dec 17.PMID: 24076493Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Consensus Development Conference | Journal ArticleSubject headings: *Adenosine Diphosphate/tu [Therapeutic Use] | *Angioplasty, Balloon, Coronary | *Hemorrhage/et [Etiology] | *Myocardial Ischemia/et [Etiology] | *Platelet Aggregation Inhibitors/tu [Therapeutic Use] | *Platelet Function Tests | *Purinergic P2Y Receptor Antagonists/tu [Therapeutic Use] | Acute Coronary Syndrome/th [Therapy] | Blood Platelets/de [Drug Effects] | Coronary Artery Disease/th [Therapy] | Coronary Thrombosis/et [Etiology] | Coronary Thrombosis/pc [Prevention & Control] | Humans | Receptors, Purinergic P2Y12/de [Drug Effects] | Risk Assessment | Risk Factors | Stents/ae [Adverse Effects]Year: 2013 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:

0735-1097

Name of journal: Journal of the American College of CardiologyAbstract: 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 P2Y12 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 P2Y12 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. Copyright 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.All authors: Alexopoulos D, Angiolillo DJ, Aradi D, Becker RC, Bhatt DL, Bonello L, Curzen N, Geisler T, Gurbel PA, Jeong YH, Kirtane A, Mahla E, Marcucci R, Price MJ, Rao SV, Reny JL, Sibbing D, Siller-Matula J, Stone GW, Tantry US, Ten Berg J, Trenk D, Waksman R, Working Group on On-Treatment Platelet ReactivityFiscal year: FY2014Digital Object Identifier:

http://dx.doi.org/10.1016/j.jacc.2013.07.101

Date added to catalog: 2014-02-24

Holdings ( 1 )
Title notes ( 3 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	24076493	Available		24076493

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

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 P2Y12 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 P2Y12 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. Copyright 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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