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

Matthias K. Freynhofer
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
,
Susanne C. Gruber
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
,
Erik L. Grove
2   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Thomas W. Weiss
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
,
Johann Wojta
3   Medical University of Vienna, 2nd Medical Department, Vienna, Austria
4   Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
,
Kurt Huber
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
4   Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Received: 26 February 2015

Accepted after major revision: 27 July 2015

Publication Date:
21 November 2017 (online)

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.

 
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