Box-1
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention (1)
Class IIb
1. Platelet function testing may be considered in patients at high risk for poor clinical
outcomes. (Level of Evidence: C)
2. In patients treated with clopidogrel with high platelet reactivity, alternative agents,
such as prasugrel or ticagrelor, might be considered. (Level of Evidence: C)
Class III: No Benefit
1. The routine clinical use of platelet function testing to screen patients treated with
clopidogrel who are undergoing PCI is not recommended. (Level of Evidence: C)
2012 ACC/AHA Focused Update for the Management of Patients with UA/NSTEMI (2)
Class IIb
1. Platelet function testing to determine platelet inhibitory response in patients with
UA/NSTEMI (or, after ACS and PCI) on
P2Y12 receptor inhibitor therapy may be considered if results of testing may alter
management. (Level of Evidence: B)
2011 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients
Presenting Without Persistent ST-segment Elevation (3)
Class IIb
1. Genotyping and/or platelet function testing may be considered in selected cases when
clopidogrel is used. (Level of Evidence: B)
2. Increasing the maintenance dose of clopidogrel based on platelet function testing is not
advised as routine, but may be considered in selected cases. (Level of Evidence: B)
3. When it is considered appropriate to have a modest degree of P2Y12 inhibition at the time
of surgery, such as is often the case early after an ACS for patients undergoing CABG
surgery, then the drugs may be discontinued closer to the time of surgery. Under these
circumstances, it is reasonable to stop clopidogrel 5 days before surgery, or less, if a validated
platelet function testing method shows a poor response to clopidogrel.
4. The routine clinical use of platelet function tests in clopidogrel-treated patients with ACS
cannot be recommended.
Box-2
1
2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in
patients having cardiac and noncardiac operations (70)
Treatment options for patients on antiplatelet drugs who require urgent operations
Class IIa
For patients on dual antiplatelet therapy, it is reasonable to make decisions about surgical
delay based on tests of platelet inhibition rather than arbitrary use of a specified period of
surgical delay. (Level of evidence B)
Monitoring platelet function
Class IIb
Because of their high negative predictive value, preoperative point-of-care testing to assess
bleeding risk may be useful in identifying patients with high residual platelet reactivity after
usual doses of antiplatelet drugs, and who can undergo operation without elevated bleeding
risk. (Level of evidence B)
Point-of-care testing to assess perioperative platelet function may be useful in limiting blood
transfusion. (Level of evidence B)
Antiplatelet drugs after cardiac operations
Class IIb
Once postoperative bleeding risk is decreased, testing of response to antiplatelet drugs, either
with genetic testing or with point-of-care platelet function testing, early after cardiac
procedures might be considered to optimize antiplatelet drug effect and minimize thrombotic
risk to vein grafts. (Level of evidence B)
For patients with high platelet reactivity after usual doses of clopidogrel, it may be helpful to
switch to another P2Y12 inhibitor (eg, prasugrel or ticagrelor).
2