Current evidence for monitoring platelet reactivity in acute coronary syndrome: A plea for individualized antiplatelet treatment

Although clopidogrel is more effective in preventing thrombotic complications than aspirin alone in a broad spectrum of patients with ischemic heart disease, many of its limitations were recently brought to light including a delayed onset of action and highly unpredictable P2Y12-receptor inhibition. New-generation ADP-receptor antagonists, such as prasugrel and ticagrelor, were designed and developed to overcome these limitations, providing a more rapid, more reliable and more potent P2Y12-receptor inhibition. These pharmacodynamic benefits of new-generation antiplatelet agents were translated into significant clinical advantage among patients with acute coronary syndrome (ACS), especially in preventing stent thrombosis. However, the downsides of the unselected use of novel P2Y12-receptor antagonists include higher risk of bleeding and increased costs. Platelet reactivity testing might become a useful tool to help balance between bleeding and thrombosis with P2Y12-receptor antagonists; however, its role in clinical practice for patients undergoing percutaneous coronary intervention (PCI) remains uncertain. The aim of this viewpoint article is to summarize the currently available evidence supporting a role of platelet function testing in patients with ACS after PCI.