Platelet function testing and risk of bleeding complications
Abstract
Antiplatelet therapy has a key role in preventing atherothrombotic events in patients with coronary artery disease, particularly in those undergoing revascularisation procedures. However, this may occur at the expense of an increase risk of bleeding. Therefore, the balance between thrombotic and bleeding events is critical in order to achieve optimal outcomes. Since there is a broad variability in individual response profiles to antiplatelet therapy, these outcomes (thrombosis vs. bleeding) may depend on the level of platelet inhibition achieved in a given subject. Platelet function assays have emerged as a useful tool for its potential to determine patients at a higher risk of ischaemic and bleeding complications. The present manuscript will review the available evidence associating platelet function testing with adverse clinical outcomes, in particular bleeding, and their potential applications in lieu of novel and more potent antithrombotic agents that will be introduced into clinical practice in the near future.
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Multiplate results correlate well with bleeding and thromboembolic complications in patients undergoing coronary stenting and cardiac surgery.
“Of note, Multiplate results have been shown to bear a good correlation to bleeding and thromboembolic complications in patients undergoing coronary stenting and cardiac surgery.44,45”
From Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients (2012) · cites this paper as [44]
POC tests can detect tissue factor expression on circulating cells, fibrin polymerization disorders (e.g., from colloid infusion), hyperfibrinolysis, and platelet dysfunction due to cardiopulmonary bypass or antiplatelet drugs.
“Therefore, they are able to detect tissue factor expression on circulating cells, fibrin polymerization disorders, e.g., due to colloid infusion, hyperfibrinolysis, as well as platelet dysfunction due to CPB or antiplatelet drugs.38 -44”
From Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients (2012) · cites this paper as [44]
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Weber, C., & Lip, G. (2012) · Thrombosis and Haemostasis · doi:10.1055/s-0037-1608981 · Cited by 3 · see citing works
“Fresh insight in available evidence associating platelet function testing with adverse clinical outcomes, in particular bleeding, and their potential applications in view of novel and more potent antithrombotic agents that will be introduced into clinical practice in the near future, summarising facts and fiction in r…”
BackgroundGallego-Fábrega, C., Krupinski, J., & Fernandez-Cadenas, I. (2015) · Neurología · doi:10.1016/j.nrl.2013.11.003 · Cited by 2 · see citing works
“Consecuentemente, los polimorfismos que se han visto asociados con la actividad plaquetaria tampoco presentan una asociación clara con la recurrencia vascular 27,29 .”
Variability of prasugrel antiplatelet effect in patients with acute coronary syndrome
Kasprzak, M., Molska, M., Obońska, K., Kolasińska, E., Kubica, J., Arndt, A., Laskowska, E., Obońska, E., Ewertowska, M., Sikora, J., et al. (2015) · doi:10.5603/fmc.2015.0006 · Cited by 2
Bonhomme, F. (2016) · Transfusion Clinique et Biologique · doi:10.1016/j.tracli.2016.08.001 · Cited by 3 · see citing works
“[3] Ferreiro JL, Sibbing D, Angiolillo DJ.”
BackgroundZhu, G.-L., Chen, X.-L., Huang, X.-Y., Tan, Q.-D., Cao, Q., Yang, Y.-L., Lin, Y.-P., & Yang, J. (2026) · Neuroprotection · doi:10.1002/nep3.70057 · Cited by 1
“51,52 Similar to HOPR, LOPR thresholds vary by PFT method (see Table 1) and commonly occur with pra-sugrel, ticagrelor, or high ‐ dose clopidogrel.”
Platelet function and microvesicle generation in patients with hemophilia A
Melero-Amor, A., Romecín, P., Iyú, D., García-Bernal, D., García‐Navaro, E., Moraleda, J., García-Estañ, J., García-Candel, F., & Atucha, N. (2020) · Clinical Case Reports · doi:10.1002/ccr3.3788 · Cited by 1
“6 There are conflicting results in the literature, even from the same laboratory (2224), but it seems that our results agree with most of these studies, both in human patients (23, 25) and mice (24), thus suggesting that there is no platelet activation in patients with severe HA.”
ResultGrigoryev, E. V., SHUKEVICH, D. L., Плотников, Г. П., Gruzdeva, O. V., Fanaskova, E. V., Сергеевич, А. С., & Барбараш, О. Л. (2015) · Russian Journal of Cardiology and Cardiovascular Surgery · doi:10.17116/kardio20158567-73 · Cited by 1 · see citing works
Dual Antiplatelet Therapy with Clopidogrel and Aspirin for Secondary Stroke Prevention
Wang, Y.-L., Chen, W.-Q., & Wang, Y.-J. (2015) · Current Cardiology Reports · doi:10.1007/s11886-015-0642-4 · Cited by 1 · see citing works
Bleeding and Thrombosis Risk Matters
Sibbing, D., Groß, L., Orban, M., & Maßberg, S. (2013) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2013.06.002 · Cited by 1 · see citing works
Self-citationGenetic Considerations of Antiplatelet Therapy
Rollini, F., Tello-Montoliu, A., & Angiolillo, D. (2014) · doi:10.1002/9781118504499.ch6
Self-citationVerifyNow P2Y12 and Plateletworks Assays
Price, M. J., Breet, N. J., & ten Berg, J. M. (2014) · Wiley eBooks · doi:10.1002/9781118493984.ch9
Pharmacodynamics- and Pharmacogenetics-Guided Antiplatelet Therapy
Tello-Montoliu, A., & Angiolillo, D. (2014) · doi:10.1201/b15465-24
Self-citationClinically relevant concepts of haemostasis and detection of coagulopathy after trauma and surgery.
Windeløv, N. A., & Rasmussen, L. S. (2013) · Revista Española de Anestesiología y Reanimación · doi:10.1016/j.redar.2013.09.001
“Indeed, excessive inhibition increases the risk of bleeding events whereas insufficient inhibition increases the risk of ischaemic events.(19) We recently investigated performed a prospective study of platelet function in non-medicated 213 severely trauma patients.”
BackgroundCharacterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting
Lalama, J. (2011) · doi:10.4172/2155-9880.1000155
“There currently is little data to support the use of pointof-care P2Y12 testing to assess for bleeding risks with clopidogrel [17,18].”
BackgroundDoes Platelet Function Testing Predict Bleeding?-Pro
Fantz, C. R., & Winkler, A. (2011) · doi:10.1097/poc.0b013e318228be6b
New insights into platelet function testing: From bench to bedside
Varon, D., & Huber, K. (2011) · Thrombosis and Haemostasis · doi:10.1160/th11-07-0467
“Of course, aspirin dose can influence platelet physiology (19), but ultimately, platelet (dys)function is associated with bleeding (20).”
BackgroundVuković, D., Živković, T., Todorović, M., Čalija, B., Vukovic, P. M., & Balint, B. (2020) · Medicinska rec · doi:10.5937/medrec2003119v
Antithrombotic Issues in Women
Muñiz‐Lozano, A., Rollini, F., Franchi, F., Cho, J. R., & Angiolillo, D. J. (2013) · Springer eBooks · doi:10.1007/978-1-4471-5517-1_15
Self-citationTraitement des hématomes intracrâniens
Vigué, B., & Leblanc, P. (2013) · doi:10.1007/978-2-287-99031-1_9
Platelet reactivity over time: Solid as a rock or not durable?
van Werkum, J. V., & ten Berg, J. T. (2011) · Thrombosis and Haemostasis · doi:10.1160/th10-11-0760
“In addition, the HPRthreshold concept has implications for personalised medicine by tailoring an individual’s magnitude of on-treatment platelet reactivity to a therapeutic window or so called “sweet spot” because several studies demonstrated a clear relationship between HPR and the occurence of atherothrombotic event…”
Background
- Authors
- Ferreiro, J. L., Sibbing, D., & Angiolillo, D.
- Affiliations
- University of Florida (US)
- TUM Klinikum (DE)
- Corresponding author
- Angiolillo, Dominick
- Venue
- Thrombosis and Haemostasis
- Publisher
- Georg Thieme Verlag KG
- Published
- 2010
- Volume
- 103
- Issue
- 06
- Pages
- 1128-1135
- ISSN
- 0340-6245 (ISSN-L)
- 2567-689X
- OpenAlex
- W2049447474
- Cited by
- 104
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 7 · 2014: 8 · 2013: 17 · 2012: 23
- FWCI
- 13.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Hematology › Platelet Disorders and Treatments
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- platelet function testing, bleeding complications, antiplatelet therapy, coronary artery disease, revascularization, platelet aggregation inhibition, thrombosis, atherothrombotic events
- MeSH terms
- Clinical Trials as Topic, Coronary Artery Disease, Coronary Thrombosis, Hemorrhage, Humans, Platelet Aggregation Inhibitors, Platelet Function Tests, Prognosis, Thrombolytic Therapy, Treatment Outcome
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