Antiplatelet drugs in patients with enhanced platelet turnover: biomarkers versus platelet function testing

Matthias K. Freynhofer; Susanne C. Gruber; Erik L. Grove; Thomas W. Weiss; Johann Wojta; Kurt Huber

doi:10.1160/TH15-02-0179

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 114(03): 459-468
DOI: 10.1160/TH15-02-0179

Theme Issue Article

Schattauer GmbH

Antiplatelet drugs in patients with enhanced platelet turnover: biomarkers versus platelet function testing

Authors

Matthias K. Freynhofer

¹3^rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
Susanne C. Gruber

¹3^rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
Erik L. Grove

²Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Thomas W. Weiss

¹3^rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
Johann Wojta

³Medical University of Vienna, 2^nd Medical Department, Vienna, Austria

⁴Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
Kurt Huber

¹3^rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria

⁴Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria

Abstract

Summary

Platelets are key players in atherothrombosis. Antiplatelet therapy comprising aspirin alone or with P2Y₁₂-inhibitors are effective for prevention of atherothrombotic complications. However, there is interindividual variability in the response to antiplatelet drugs, leaving some patients at increased risk of recurrent atherothrombotic events. Several risk factors associated with high on-treatment platelet reactivity (HTPR), including elevated platelet turnover, have been identified. Platelet turnover is adequately estimated from the fraction of reticulated platelets. Reticulated platelets are young platelets, characterised by residual messenger RNA. They are larger, haemostatically more active and there is evidence that platelet turnover is a causal and prognostic factor in atherothrombotic disease. Whether platelet turnover per se represents a key factor in pathogenesis, progression and prognosis of atherothrombotic diseases (with focus on acute coronary syndromes) or whether it merely facilitates insufficient platelet inhibition will be discussed in this state-of-the art review.

Keywords

Platelet turnover - reticulated platelets - mean platelet volume - P2Y₁₂ inhibitors - aspirin

Full Text

References

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