Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Conclusion of Interdisciplinary Expert Council of Russian Association of Angiologists and Vascular Surgeons, Russian Scientific Society of Endovascular Surgeons and Interventional Radiologists, National Stroke Association, National Scientific Inflammation Society The Conclusion of Interdisciplinary Expert Council on the significance of testing of platelet functional activity in the prevention of cardiovascular complications in patients receiving antiplatelet therapy is presented. Indications for antiplatelet therapy, relation of platelet reactivity with the risk of adverse events, as well as factors that contribute to high residual platelet reactivity in patients receiving antiplatelet therapy are considered. The results of studies on the correction of antiplatelet therapy based on aggregometry data, indications for its implementation in clinical practice, as well as methods for evaluation of residual platelet reactivity are discussed separately.

About the Author

D. A. Andreev

Russian Federation


1. Belenkov YN, Oganov RG. Cardiology: national guidance. Moscow: GEOTAR-Media; 2010. Russian (Беленков Ю.Н., Оганов Р.Г. Кардиология: национальное руководство. М.: ГЭОТАР-Медиа; 2010).

2. Boytsov SA, Chuchalin AG, Arutyunov GP, et al. Prevention of chronic noninvasive-infectious diseases. Recommendations. Moscow; 2013. Available at: Accessed by 06/12/2014. Russian (Бойцов С.А., Чучалин А.Г., Арутюнов Г.П. и др. Профилактика хронических неинфекционных заболеваний. Рекомендации. М.; 2013. Доступно на: Проверено 06.12.2014).

3. National guidelines for cardiovascular prevention. Kardiovaskulyarnaya Terapiya i Profilaktika 2011; 10 (6) suppl 2: 1-64. Russian (Национальные рекомендации по кардиоваскулярной профилактике. Кардиоваскулярная Терапия и Профилактика 2011; 10 (6) приложение 2: 1-64).

4. Martsevich SY, Kutishenko NP, Ginzburg ML, et al. Efficacy, safety, and adherence to antiplatelet therapy in patients at high risk of thrombotic complications. Available at: Accessed by 06/12/2014. Russian (Марцевич С.Ю., Кутишенко Н.П., Гинзбург М.Л. и др. Эффективность, безопасность и приверженность антитромбоцитарной терапии у пациентов с высоким риском тромботических осложнений. Доступно на: Проверено 06.12.2014).

5. Fuster V. Guided Antithrombotic Therapy: Current Status and Future Research Direction. Report on a National Heart, Lung and Blood Institute Working Group. Circulation 2012;126:1645-62.

6. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947

7. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke 2014;45: 2160-236.

8. Montalescot G, Sechtem U, Achenbach S, et al. ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013; 34: 2949-3003.

9. Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 2012; 33: 1635-701.

10. Wenger N.K. 2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): Highlights for the Clinician. Clin Cardiol 2012; 35(1): 3-8.

11. Windecker S, Kolh P, Alfonso F, et al 2014 ESC/EACTS Guidelines on myocardial Revascularization. Eur Heart J 2014;35(37):2541-619.

12. Giorgi MA, Di Girolamo G, González CD. Nonresponders to clopidogrel: pharmacokinetics and interactions involved. Expert Opin. Pharmacother 2010; 11(14):2391-403.

13. The Global Registry of Acute Coronary Events. Available at: Accessed by 06.12.2014

14. Trenk D, Stone GW, Gawaz M, et al. A Randomised Trial of Prasugrel Versus Clopidogrel in Patients With High Platelet Reactivity on Clopidogrel After Elective Percutaneous Coronary Intervention With Implantation of Drug-Eluting Stents: Results of the TRIGGER-PCI (Testing Platelet Reactivity In Patients Undergoing Elective Stent Placement on Clopidogrel to Guide Alternative Therapy With Prasugrel) Study. J Am Coll Cardiol 2012; 59: 2159-64.

15. Garabedian T., Alam S. High residual platelet reactivity on clopidogrel: its significance and therapeutic challenges overcoming clopidogrel resistance. Cardiovasc Diagn Ther 2013;3(1):23-37.

16. Cattaneo M, Cerletti C, Harrison P, et al. Recommendations for the standardization of light transmission aggregometry: a consensus of the working party from the platelet physiology subcommittee of SSC/IS TH. J Thromb Haemost 2013; 11: 1183-9.

17. Stone GW, Witzenbichler B, Weisz G, et al, Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet 2013;382(9892):614-23.

18. Witzenbichler B. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPTDES) study. Circulation 2014;129(4):463-70.

19. Janssen P.W.A., ten Berg J. M., Hackeng C. M. The use of platelet function testing in PCI and CABG patients. Blood Rev 2014; 28(3): 109-21.

20. Bonello L, Mancini J, Pansieri M, et al. Relationship between post-treatment platelet reactivity and ischemic and bleeding events at 1-year follow-up in patients receiving prasugrel. J Thromb Haemost 2012;10:1999-2005.

21. Campo G, Parrinello G, Ferraresi P, et al. Prospective evaluation of on-clopidogrel platelet reactivity over time in patients treated with percutaneous coronary intervention relationship with gene polymorphisms and clinical outcome. J Am Coll Cardiol 2011;57:2474-83.

22. Sibbing D, Steinhubl SR, Schulz S, et al. Platelet aggregation and its association with stent thrombosis and bleeding in clopidogrel-treated patients: initial evidence of a therapeutic window. J Am Coll Cardiol 2010;56: 317-8.

23. Larsen SB, Grove EL, Hvas AM, Kristensen SD. Platelet Turnover in Stable Coronary Artery Disease Influence of Thrombopoietin and Low-Grade Inflammation. PLoS One 2014;9(1):e85566.

24. Lordkipanidze M. Platelet Turnover in Atherothrombotic Disease. Current Pharmaceutical Design 2012;18 (33):5328-43.

25. Mega JL, Close SL, Wiviott SD, et al. Cytochrome P450 Genetic Polymorphisms and the Responseto Prasugrel Relationship Pharmacokinetic, Pharmacodynamic, and Clinical Outcomes. Circulation 2009;119:2553-60.

26. Morel O, Muller C, Jesel L, et al. Impaired platelet P2Y12 inhibition by thienopyridines in chronic kidney disease: mechanisms, clinical relevance and pharmacological options. Nephrol Dial Transplant 2013;28(8):1994-2002.

27. Snoep JD, Hovens MM, Eikenboom JC, et al. Clopidogrel nonresponsiveness in patients undergoing percutaneous coronary intervention with stenting: a systematic review and meta-analysis. Am Heart J 2007;154 (2):221-31.

28. Mirzayev KB, Sychev DA, DA Andreev, Prokofiev AB. The value of pharmacogenetic testing for SYP2S19 to personalize the use of antiplatelet agents in cardiology practice. Ration Pharmacother Cardiol 2013; (4): 404-8. Russian (Мирзаев К.Б., Сычев Д.А., Андреев Д.А., Прокофьев А.Б. Значение фармакогенетического тестирования по СYP2С19 для персонализации применения антиагрегантов в кардиологической практике. Рациональная Фармакотерапия в Кардиологии 2013;(4): 404-8).

29. Campo G, Fileti L, de Cesare N, et al. Long-Term Clinical Outcome Based on Aspirin and Clopidogrel Responsiveness Status After Elective Percutaneous Coronary Intervention A 3T/2R (Tailoring Treatment With Tirofiban in Patients Showing Resistance to Aspirin and/or Resistance to Clopidogrel) Trial Substudy. J Am Coll Cardiol 7 2010;56:1447-55.

30. Mahla E. Platelet Function Measurement–Based Strategy to Reduce Bleeding and Waiting Time in Clopidogrel-Treated Patients Undergoing Coronary Artery Bypass Graft Surgery. The Timing Based on Platelet Function Strategy to Reduce Clopidogrel-Associated Bleeding Related to CABG (TARGET-CABG) Study. Circ Cardiovasc Interv 2012;5:261-9.

31. Mirzaev K., Sychev D. Cytochrome 2C19 Enzyme Polymorphism Frequency in Different Indigenous Ethnic Groups in Russian Federation: A Systematic Review. J Pharmacogenomics Pharmacoproteomics 2014; 5:3

32. Laine M, Toesca R, Berbis J, et al. Platelet reactivity evaluated with the VASP assay following ticagrelor loading dose in acute coronary syndrome patients undergoing percutaneous coronary intervention. Thromb Res 2013;132(1):e15-8.

33. Aradi D, Komócsi A, Price MJ, et. al. Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention: Systematic review and meta-analysis. Int J Cardiol 2013;167(5):2140-8.

34. Siller-Matula JM, Francesconi M, Dechant C, et al. Personalized antiplatelet treatment after percutaneous coronary intervention: The MADONNA study. Int J Cardiol 2013;167(5):2018-23.

35. Siller-Matula JM1, Gruber C2, Francesconi M, et al.The net clinical benefit of personalized antiplatelet therapy in patients undergoing percutaneous coronary intervention. Clin Sci (Lond) 2015;128(2):121-30.

36. Aradi D, Tornyos A, Pintér T, et al. Optimizing P2Y12 Receptor Inhibition in Patients With Acute Coronary Syndrome on the Basis of Platelet Function Testing Impact of Prasugrel and High-Dose Clopidogrel. JACC 2014; 63(11): 1061-70.

37. Aradi D, Storey RF, Komócsi A, et al. Expert position paper on the role of platelet function testing in patients undergoing percutaneous coronary intervention. Eur Heart J 2014; 35: 209-15.

38. Ferraris VA, Saha SP, Oestreich JH, et al. 2012 Update to The Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations. Ann Thorac Surg 2012; 94:1761-81.

39. Kristensen S.D. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J 2014;35(35):2383-431.

40. Gomez Y, Adams E, Hoogmartens J. Analysis of purity in 19 drug product tablets containing clopidogrel: 18 copies versus the original brand. J Pharm Biomed Anal 2004;34(2):341-8.


For citations:


Views: 685

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)