Platelet Reactivity: Is There a Role to Switch?

Antiplatelet agents are essential to prevent thrombotic events in patients with coronary artery disease, especially in those with acute coronary syndrome or undergoing percutaneous coronary intervention (PCI). However, the benefits of antiplatelet therapy always come at a price of increased risk for bleeding, and the clinical values of antiplatelet strategies depend on this characteristic benefit/risk ratio. Platelet function testing aiming at determining an individual's response to the administered agent was hoped to help balance bleeding and thrombosis in order to maximize benefit/risk ratio. However, randomized trials failed to demonstrate an improved clinical outcome of a platelet function-based treatment selection and consequently platelet function testing has not become a routine part of the management of antiplatelet therapies. This review aims to discuss results and shortcomings of available trials and registries regarding the potential role of platelet reactivity testing in guiding antiplatelet treatment selection in patients undergoing PCI.