How I use laboratory monitoring of antiplatelet therapy

Blood. 2017 Aug 10;130(6):713-721. doi: 10.1182/blood-2017-03-742338. Epub 2017 Jun 9.

Abstract

Antiplatelet therapy is of proven benefit in coronary artery disease and a number of other clinical settings. This article reviews platelet function, molecular targets of antiplatelet agents, and clinical indications for antiplatelet therapy before focusing on a frequent question to hematologists about the 2 most commonly used antiplatelet therapies: Could the patient be aspirin "resistant" or clopidogrel "resistant"? If so, should results of a platelet function test be used to guide the dose or type of antiplatelet therapy? Whether such guided therapy is of clinical benefit to patients has been a source of controversy. The present article reviews this subject in the context of 2 prototypical clinical cases. Available evidence does not support the use of laboratory tests to guide the dose of aspirin or clopidogrel in patients with so-called aspirin or clopidogrel "resistance."

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Aspirin / therapeutic use*
  • Blood Platelets / cytology
  • Blood Platelets / drug effects*
  • Blood Platelets / metabolism
  • Clopidogrel
  • Drug Monitoring / methods*
  • Humans
  • Male
  • Middle Aged
  • Molecular Targeted Therapy / methods
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Platelet Function Tests / methods
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin