Dual antiplatelet
therapy with
aspirin and a P2Y12 receptor blocker is a well-established strategy to prevent thrombotic complications in patients with
acute coronary syndromes (ACS) and after
percutaneous coronary interventions (PCI). Current practice guidelines for antiplatelet
therapy advocate a 1 to 12-month dual antiplatelet
therapy after bare
metal stent PCI and an up to 12-month dual antiplatelet
therapy after PCI in patients with ACS and
drug-eluting stent PCI. Premature withdrawal of dual antiplatelet
therapy carries a substantial risk of
stent thrombosis but perioperative continuation of dual antiplatelet
therapy is associated with an increased risk of
bleeding, particularly in patients treated with the new potent drugs
prasugrel and
ticagrelor. Based on the various available assays, the lack of validated cut-offs and the disappointing results of targeted antiplatelet
therapy as demonstrated by the GRAVITAS trial, current guidelines of international societies recommend platelet function testing only for selected high risk patients despite the known association between
clopidogrel low responsiveness and ischemic events. However, for individual patients taking
clopidogrel, platelet function monitoring may be considered to safely shorten the preoperative waiting period, to assess the risk of
bleeding and transfusion and to initiate specific
therapy in
bleeding patients.