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Why have studies of tailored anti-platelet therapy failed so far?

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
Obesity and vascular disease

DOI: http://dx.doi.org/10.1160/TH13-03-0250
Issue: 2013: 110/4 (Oct) pp. 623-856
Pages: 628-631

Why have studies of tailored anti-platelet therapy failed so far?

J. M. Siller-Matula (1), B. Jilma (2)

(1) Department of Cardiology, Medical University of Vienna, Austria; (2) Department of Clinical Pharmacology, Medical University of Vienna, AustriaDepartment of Clinical PharmacologyMedical University of Vienna, Austria

Summary

Published data linking clopidogrel non-responsiveness to adverse ischaemic events lead to the suggestion that the magnitude of platelet inhibition by clopidogrel can be monitored and individually adjusted. This has been tested in randomised clinical trials (ARCTIC, GRAVITAS and TRIGGER-PCI), but despite reducing platelet reactivity, a strategy of therapy adjustment based on platelet function monitoring did not reduce the incidence of cardiac ischaemic events. Several critical issues regarding the design of these trials, which might in part have led to negative results, are discussed in this article.