CAROTID ARTERY  UPDATE ON MANAGEMENT OF CAROTID, AORTIC AND PERIPHERAL ARTERIAL PATHOLOGIES 

The Journal of Cardiovascular Surgery 2015 April;56(2):165-75

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

The role of perioperative antiplatelet therapy and platelet reactivity testing in carotid revascularization: overview of the evidence

Leunissen T. C. ¹, De Borst G. J. ¹, Janssen P. W. A. ^{2, 3}, Ten Berg J. M. ^{2, 3} ✉

¹ Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands; ² Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands; ³ St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, The Netherlands

Antiplatelet therapy has reduced the incidence of thromboembolic events for patients undergoing carotid revascularization. However, the platelet inhibitory effect of aspirin and clopidogrel, the most commonly used P2Y12 receptor inhibitors, is variable among patients. Patients displaying high platelet reactivity despite aspirin or clopidogrel treatment are at higher risk for thromboembolic events during and after carotid revascularization. In order to reduce the incidence of high platelet reactivity, more potent P2Y12 receptor inhibitors as prasugrel are used. However, this strategy increases the risk of bleeding. As there is evidence of a therapeutic window for platelet inhibition, platelet function tests could be helpful for tailoring antiplatelet therapy based on the patient’s thrombotic and bleeding risk. This evidence overview describes the most commonly used platelet inhibitors, platelet function tests and the current evidence for tailoring of antiplatelet therapy to patients undergoing carotid revascularization.