阿司匹林和P2Y12受体阻滞剂的双重抗血小板治疗是降低经皮冠状动脉介入治疗患者血小板反应性和预防血栓事件的关键策略。在较早的共识文件中,对于各种血小板功能试验(PFTs),我们提出了与经皮冠状动脉介入治疗后缺血事件相关的高治疗时血小板对二磷酸腺苷(ADP)反应性的临界值.更新的美国和欧洲实践指南已发布了PFT的IIb类建议,以促进在接受经皮冠状动脉介入治疗的选定高危患者中选择P2Y12受体抑制剂。尽管不建议进行常规测试(III类)。来自大型研究的累积数据强调了对ADP的高治疗血小板反应性作为预后危险因素的重要性。最近PFT的前瞻性随机试验没有显示临床益处,因此质疑基于当前PFT平台结果的治疗修改是否会真正影响结局.然而,这些随机试验存在主要的局限性.此外,最近的数据表明,治疗中血小板对ADP的反应性低与出血风险较高相关.因此,已经提出了P2Y12抑制剂治疗的治疗窗口概念.在这份更新的共识文件中,我们回顾了血小板反应性与血栓和出血事件关系的现有证据.此外,我们提出了治疗中血小板对ADP的高反应性和低反应性的截断值,该截断值可用于未来个性化抗血小板治疗的研究.
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.