Results indicated that some PFTs may have some prognostic utility , i.e. a trend for more clinical events to be associated with groups classified as ' aspirin resistant ' .
Study -level effect sizes were generally small and absolute outcome risk was not substantially different between ' aspirin resistant ' and ' aspirin sensitive ' design ations .
Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification , the economic model found that a test-treat strategy was likely to be cost-effective .
However , neither assumption is currently evidence based .
BACKGROUND The use of aspirin is well established for secondary prevention of cardiovascular disease .
However , a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment .
It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity .
This report aims to investigate whether or not insufficient platelet function inhibition by aspirin ( ' aspirin resistance ' ) , as defined using platelet function tests ( PFTs ) , is linked to the occurrence of adverse clinical outcomes , and further , whether or not patients at risk of future adverse clinical events can be identified through PFTs .
OBJECTIVES To review systematic ally the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT design ation of ' aspirin resistance ' and the risk of adverse clinical outcome ( s ) in patients prescribed aspirin therapy .
To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs .
Platelet reactivity to adenosine diphosphate and long-term ischemic event occurrence following percutaneous coronary intervention: A potential antiplatelet therapeutic target
Platelets play a central role in the genesis of post-percutaneous coronary intervention ( PCI ) ischemic events . High post-procedural platelet reactivity to adenosine diphosphate ( HPRADP ) may be a risk factor for ischemic events after PCI . The study was design ed to evaluate a cutpoint of platelet reactivity that is associated with the occurrence of ischemic events after PCI . Post-procedural platelet reactivity to ADP was measured by conventional aggregometry in 297 consecutive patients undergoing non-emergent PCI . Patients were prospect ively followed for up to 2 years for post-discharge ischemic events . All patients had received  clopidogrel and aspirin therapy  at the time of aggregation measurements . Eighty-one patients ( 27 % ) suffered ischemic events . Patients with ischemic events had higher 5 µM ADP-induced platelet aggregation ( 46 ± 14 % vs. 30 ± 17 % , p < 0.001 ) and 20 µM ADP-induced platelet aggregation ( 60 ± 13 % vs. 43 ± 19 % , p < 0.001 ) compared to patients without ischemic events . Using a combined receiver operator curve analysis , cutpoints of > 46 % aggregation following 5 µM ADP stimulation and > 59 % aggregation following 20 µM ADP stimulation ( HPRADP ) were associated with 58 and 54 % of ischemic events , respectively . Multivariate Cox regression demonstrated a significant relation between event occurrence and post-procedural HPRADP cutpoints ( 5 µM ADP , OR=3.9 , and 20 µM ADP , OR=3.8 , p < 0.001 for both ) . High post-procedural platelet reactivity to ADP is an independent risk factor for ischemic events within 2 years of non-emergent PCI . These data support a potential therapeutic target for antiplatelet therapy based on the results of an ex vivo platelet function test . The study is a step towards a personalized medicine approach to guide the intensity of antiplatelet therapy
Results indicated that some PFTs may have some prognostic utility , i.e. a trend for more clinical events to be associated with groups classified as ' aspirin resistant ' .
Study -level effect sizes were generally small and absolute outcome risk was not substantially different between ' aspirin resistant ' and ' aspirin sensitive ' design ations .
Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification , the economic model found that a test-treat strategy was likely to be cost-effective .
However , neither assumption is currently evidence based .
BACKGROUND The use of aspirin is well established for secondary prevention of cardiovascular disease .
However , a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment .
It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity .
This report aims to investigate whether or not insufficient platelet function inhibition by aspirin ( ' aspirin resistance ' ) , as defined using platelet function tests ( PFTs ) , is linked to the occurrence of adverse clinical outcomes , and further , whether or not patients at risk of future adverse clinical events can be identified through PFTs .
OBJECTIVES To review systematic ally the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT design ation of ' aspirin resistance ' and the risk of adverse clinical outcome ( s ) in patients prescribed aspirin therapy .
To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs .