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VIEWPOINT

Platelet Function Monitoring in Patients With Coronary Artery Disease

Paul A. Gurbel, MD^_*,1, Richard C. Becker, MD^,2,_*, Kenneth G. Mann, PhD^,3, Steven R. Steinhubl, MD^,4 and Alan D. Michelson, MD^||,5

^_* Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland
Cardiovascular Thrombosis Center, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
University of Vermont, Burlington, Vermont
Division of Cardiology, University of Kentucky, Lexington, Kentucky
^|| Center for Platelet Function Studies, Departments of Pediatrics, Medicine, and Pathology, University of Massachusetts Medical School, Worcester, Massachusetts.

Manuscript received January 3, 2007; revised manuscript received July 24, 2007, accepted July 31, 2007.

^_* Reprint requests and correspondence: Dr. Richard C. Becker, Duke Clinical Research Institute, 2400 Pratt Street, Terrace Level, Room 0311, Durham, North Carolina 27705. (Email: richard.becker{at}duke.edu).

Studies focused on patient responsiveness to antiplatelet therapies, particularly aspirin and clopidogrel, have increased in recent years. However, the relations of in vivo platelet function and adverse clinical events to results of ex vivo platelet function tests remain largely unknown. This article describes current methods of measuring platelet function in various clinical and research situations and their advantages and disadvantages, reviews evidence for antiplatelet response variability and resistance, discusses the potential pitfalls of monitoring platelet function, and demonstrates emerging data supporting the positive clinical and treatment implications of platelet function testing.

Abbreviations and Acronyms   ACS = acute coronary syndromes   CAD = coronary artery disease   COX = cyclooxygenase   GP = glycoprotein   INR = international normalized ratio   LTA = light transmittance aggregometry   MACE = major adverse cardiac events   MI = myocardial infarction   PCI = percutaneous coronary intervention   VASP = vasodilator-stimulated phosphoprotein

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