rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2015-11-1-85-91rpcardio-65Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯEVALUATION OF PLATELET AGGREGATION IN CLINICAL PRACTICEОЦЕНКА АГРЕГАЦИИ ТРОМБОЦИТОВ В КЛИНИЧЕСКОЙ ПРАКТИКЕМирзаевК. Б.MirzaevK. B.

студент 6 курса

123995, Москва, ул. Баррикадная, 2/1

Barricadnaya ul. 2/1, Moscow, 123995 Russia

АндреевД. А.AndreevD. A.

д.м.н., профессор кафедры неотложной кардиологии

119991, Москва, ул. Трубецкая, 8, стр. 2

Trubetskaya ul. 8-2, Moscow, 119991 Russia

СычевД. А.SychevD. A.

д.м.н., профессор, зав. кафедрой клинической фармакологии и терапии

123995, Москва, ул. Баррикадная, 2/1

Barricadnaya ul. 2/1, Moscow, 123995 Russia

dimasychev@mail.ruРоссийская медицинская академия последипломного образованияРоссияRussian Medical Academy of Postgraduate EducationRussian FederationПервый Московский Государственный Медицинский Университет им. И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian Federation2015210920151118591Copyright © Mirzaev K.B., Andreev D.A., Sychev D.A., 20152015Мирзаев К.Б., Андреев Д.А., Сычев Д.А.Mirzaev K.B., Andreev D.A., Sychev D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/65

Evaluation of platelet function with subsequent modification of antiplatelet therapy regimen is one of the areas of personalized medicine. Analysis of the causes of inadequate antiplatelet action of clopidogrel, the association of residual platelet reactivity with clinical outcomes and a review of the research on the change of antiplatelet therapy in patients with ischemic heart disease after percutaneous interventions based on the results of platelet function testing, were the aim of this review.

Одним из направлений персонализированной медицины является оценка функции тромбоцитов с последующей модификацией схемы приема антитромбоцитарных препаратов. Целью данного обзора был анализ причин недостаточного антиагрегантного действия клопидогрела, связь остаточной реактивности тромбоцитов с клиническими исходами и обзор проведенных исследований по изменению антиагрегантной терапии у больных ишемической болезнью сердца после проведенных чрескожных вмешательств на основании результатов тестирования функции тромбоцитов.

остаточная реактивность тромбоцитовагрегометрияклопидогрелresidual platelet reactivityaggregometryclopidogrelReferencesTask Force Members, Montalescot G, Sechtem U, et al. ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34(38):2949-3003.Task Force Members, Montalescot G, Sechtem U, et al. ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34(38):2949-3003.Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33(20):2569-619.Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33(20):2569-619.Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32(23): 2999-3054.Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32(23): 2999-3054.Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361: 1045-57.Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361: 1045-57.Gurbel PA, Bliden KP, Hiatt BL, et al. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003; 107: 2908-13.Gurbel PA, Bliden KP, Hiatt BL, et al. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003; 107: 2908-13.Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357: 2001-15.Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357: 2001-15.Aradi D1, Storey RF, Komócsi A, Trenk D, Gulba D, Kiss RG et al. Expert position paper on the role of platelet function testing in patients undergoing percutaneous coronary intervention. Eur Heart J. 2014;35(4):209-15.Aradi D1, Storey RF, Komócsi A, Trenk D, Gulba D, Kiss RG et al. Expert position paper on the role of platelet function testing in patients undergoing percutaneous coronary intervention. Eur Heart J. 2014;35(4):209-15.Garabedian T, Alam S. High residual platelet reactivity on clopidogrel: its significance and therapeutic challenges overcoming clopidogrel resistance. Cardiovasc Diagn Ther 2013;3(1):23-37.Garabedian T, Alam S. High residual platelet reactivity on clopidogrel: its significance and therapeutic challenges overcoming clopidogrel resistance. Cardiovasc Diagn Ther 2013;3(1):23-37.Frelinger AL, Bhatt DL, Lee RD, et al,. Clopidogrel pharmacokinetics and pharmacodynamics vary widely despite exclusion or control of polymorphisms (CYP2C19, ABCB1, PON1), noncompliance, diet, smoking, co-medications (including proton pump inhibitors), and pre-existent variability in platelet function. J Am Coll Cardiol. 2013;61(8):872-9.Frelinger AL, Bhatt DL, Lee RD, et al,. Clopidogrel pharmacokinetics and pharmacodynamics vary widely despite exclusion or control of polymorphisms (CYP2C19, ABCB1, PON1), noncompliance, diet, smoking, co-medications (including proton pump inhibitors), and pre-existent variability in platelet function. J Am Coll Cardiol. 2013;61(8):872-9.Elsenberg EH, van Werkum JW, van de Wal RM, et al. The influence of clinical characteristics, laboratory and inflammatory markers on ’high on-treatment platelet reactivity’ as measured with different platelet function tests. Thromb Haemost 2009;102:719-27.Elsenberg EH, van Werkum JW, van de Wal RM, et al. The influence of clinical characteristics, laboratory and inflammatory markers on ’high on-treatment platelet reactivity’ as measured with different platelet function tests. Thromb Haemost 2009;102:719-27.Voisin S1, Bongard V, Tidjane MA, et al. Are P2Y12 reaction unit (PRU) and % inhibition index equivalent for the expression of P2Y12 inhibition by the VerifyNow assay? Role of haematocrit and haemoglobin levels. Thromb Haemost2011;106(2):227-9.Voisin S1, Bongard V, Tidjane MA, et al. Are P2Y12 reaction unit (PRU) and % inhibition index equivalent for the expression of P2Y12 inhibition by the VerifyNow assay? Role of haematocrit and haemoglobin levels. Thromb Haemost2011;106(2):227-9.Ang L, Palakodeti V, Khalid A, et al. Elevated plasma fibrinogen and diabetes mellitus are associated with lower inhibition of platelet reactivity with clopidogrel. J Am Coll Cardiol 2008;52:1052-9.Ang L, Palakodeti V, Khalid A, et al. Elevated plasma fibrinogen and diabetes mellitus are associated with lower inhibition of platelet reactivity with clopidogrel. J Am Coll Cardiol 2008;52:1052-9.Geisler T, Grass D, Bigalke B, et al. The residual platelet aggregation after deployment of intracoronary stent (PREDICT) score. J Thromb Haemost 2008; 6:54-61.Geisler T, Grass D, Bigalke B, et al. The residual platelet aggregation after deployment of intracoronary stent (PREDICT) score. J Thromb Haemost 2008; 6:54-61.O'Donoghue ML, Braunwald E, Antman EM, et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomized trials. Lancet 2009;374:989-97.O'Donoghue ML, Braunwald E, Antman EM, et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomized trials. Lancet 2009;374:989-97.Savi P, Herbert JM, Pflieger AM, et al. Importance of hepatic metabolism in the antiaggregating activity of the thienopyridineclopidogrel. Biochem Pharmacol. 1992;44(3):527-32.Savi P, Herbert JM, Pflieger AM, et al. Importance of hepatic metabolism in the antiaggregating activity of the thienopyridineclopidogrel. Biochem Pharmacol. 1992;44(3):527-32.Desta Z, Zhao X, Shin JG, Flockhart DA. Clinical significance of the cytochrome P450 2C19 genetic polymorphism. Clin Pharmacokinet 2002;41(12):913-58.Desta Z, Zhao X, Shin JG, Flockhart DA. Clinical significance of the cytochrome P450 2C19 genetic polymorphism. Clin Pharmacokinet 2002;41(12):913-58.Li-Wan-Po A, Girard T, Farndon P, et al. Pharmacogenetics of CYP2C19: functional and clinical implications of a new variant CYP2C19*17. Br J Clin Pharmacol 2010;69(3):222-30.Li-Wan-Po A, Girard T, Farndon P, et al. Pharmacogenetics of CYP2C19: functional and clinical implications of a new variant CYP2C19*17. Br J Clin Pharmacol 2010;69(3):222-30.Hulot JS, Bura A, Villard E, et al. Cytochrome P450 2C19 loss-of-function polymorphism is a major determinant of clopidogrel responsiveness in healthy subjects. Blood 2006; 108: 2244-47.Hulot JS, Bura A, Villard E, et al. Cytochrome P450 2C19 loss-of-function polymorphism is a major determinant of clopidogrel responsiveness in healthy subjects. Blood 2006; 108: 2244-47.Mega JL, Simon T, Collet JP et al. Reduced-function CYP2C19 genotype and risk of adverse clinical outcomes among patients treated with clopidogrel predominantly for PCI: a meta-analysis. JAMA 2010;304(16):1821-30.Mega JL, Simon T, Collet JP et al. Reduced-function CYP2C19 genotype and risk of adverse clinical outcomes among patients treated with clopidogrel predominantly for PCI: a meta-analysis. JAMA 2010;304(16):1821-30.Harmsze AM, van Werkum JW, Hackeng CM, et al. The influence of CYP2C19*2 and *17 on on-treatment platelet reactivity and bleeding events in patients undergoing elective coronary stenting. Pharmacogenet Genomics 2012;22: 169-75.Harmsze AM, van Werkum JW, Hackeng CM, et al. The influence of CYP2C19*2 and *17 on on-treatment platelet reactivity and bleeding events in patients undergoing elective coronary stenting. Pharmacogenet Genomics 2012;22: 169-75.Stone GW, Witzenbichler B, Weisz G, et al. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet 2013;382: 614-23.Stone GW, Witzenbichler B, Weisz G, et al. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet 2013;382: 614-23.Cuisset T, Frere C, Quilici J, et al. Predictive values of post-treatment adenosine diphosphate-induced aggregation and vasodilator-stimulated phosphoprotein index for stent thrombosis after acute coronary syndrome in clopidogrel-treated patients. Am J Cardiol 2009;104:1078-82.Cuisset T, Frere C, Quilici J, et al. Predictive values of post-treatment adenosine diphosphate-induced aggregation and vasodilator-stimulated phosphoprotein index for stent thrombosis after acute coronary syndrome in clopidogrel-treated patients. Am J Cardiol 2009;104:1078-82.Parodi G, Marcucci R, Valenti R, et al. High residual platelet reactivity after clopidogrel loading and longterm cardiovascular events among patients with acute coronary syndromes undergoing PCI. JAMA 2011;306:1215-23.Parodi G, Marcucci R, Valenti R, et al. High residual platelet reactivity after clopidogrel loading and longterm cardiovascular events among patients with acute coronary syndromes undergoing PCI. JAMA 2011;306:1215-23.Geisler T, Langer H, Wydymus M, et al. Low response to clopidogrel is associated with cardiovascular outcome after coronary stent implantation. Eur Heart J 2006;27:2420-5.Geisler T, Langer H, Wydymus M, et al. Low response to clopidogrel is associated with cardiovascular outcome after coronary stent implantation. Eur Heart J 2006;27:2420-5.Hochholzer W, Trenk D, Bestehorn HP, et al. Impact of the degree of peri-interventional platelet inhibition after loading with clopidogrel on early clinical outcome of elective coronary stent placement. J Am Coll Cardiol 2006;48:1742-50.Hochholzer W, Trenk D, Bestehorn HP, et al. Impact of the degree of peri-interventional platelet inhibition after loading with clopidogrel on early clinical outcome of elective coronary stent placement. J Am Coll Cardiol 2006;48:1742-50.Gurbel PA, Antonino MJ, Bliden KP, et al. Platelet reactivity to adenosine diphosphate and long-term ischemic event occurrence following percutaneous coronary intervention: a potential antiplatelet therapeutic target. Platelets 2008;19:595-604.Gurbel PA, Antonino MJ, Bliden KP, et al. Platelet reactivity to adenosine diphosphate and long-term ischemic event occurrence following percutaneous coronary intervention: a potential antiplatelet therapeutic target. Platelets 2008;19:595-604.Matetzky S, Shenkman B, Guetta V, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation. 2004;109:3171-5.Matetzky S, Shenkman B, Guetta V, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation. 2004;109:3171-5.Arpin-Bornet M, Auquier P, Sampol J, et al. Vasodilator-stimulated phosphoprotein phosphorylation analysis prior to percutaneous coronary intervention for exclusion of postprocedural major adverse cardiovascular events. J Thromb Haemost 2007;5:1630-36.Arpin-Bornet M, Auquier P, Sampol J, et al. Vasodilator-stimulated phosphoprotein phosphorylation analysis prior to percutaneous coronary intervention for exclusion of postprocedural major adverse cardiovascular events. J Thromb Haemost 2007;5:1630-36.Snoep JD, Hovens MM, Eikenboom JC, et al. Clopidogrelnonresponsiveness in patients undergoing percutaneous coronary intervention with stenting: a systematic review and meta-analysis. Am Heart J. 2007;154(2):221-31.Snoep JD, Hovens MM, Eikenboom JC, et al. Clopidogrelnonresponsiveness in patients undergoing percutaneous coronary intervention with stenting: a systematic review and meta-analysis. Am Heart J. 2007;154(2):221-31.Sofi F, Marcucci R, Gori AM, Giusti B, Abbate R, Gensini GFet al. Clopidogrel non-responsiveness and risk of cardiovascular morbidity. An updated meta-analysis. Thromb Haemost. 2010;103(4):841-8.Sofi F, Marcucci R, Gori AM, Giusti B, Abbate R, Gensini GFet al. Clopidogrel non-responsiveness and risk of cardiovascular morbidity. An updated meta-analysis. Thromb Haemost. 2010;103(4):841-8.Aradi D, Kom´ ocsi A, Vorobcsuk A, et al. Prognostic significance of high on-clopidogrel platelet reactivity after percutaneous coronary intervention: systematic review and meta-analysis. Am Heart J. 2010;160(3):543-51.Aradi D, Kom´ ocsi A, Vorobcsuk A, et al. Prognostic significance of high on-clopidogrel platelet reactivity after percutaneous coronary intervention: systematic review and meta-analysis. Am Heart J. 2010;160(3):543-51.Brar SS, ten Berg J, Marcucci R, et al. Impact of platelet reactivity on clinical outcomes after percutaneous coronary intervention. A collaborative meta-analysis of individual participant data. J Am Coll Cardiol. 2011;58:1945-54.Brar SS, ten Berg J, Marcucci R, et al. Impact of platelet reactivity on clinical outcomes after percutaneous coronary intervention. A collaborative meta-analysis of individual participant data. J Am Coll Cardiol. 2011;58:1945-54.Kirtane AJ, Rinaldi M, Parise H, et al. Impact of Point-of-Care Platelet Function Testing among Patients with and without Acute Coronary Syndromes Undergoing PCI with Drug-Eluting Stents: an Adapt-Des Substudy. J Am Coll Cardiol 2012;59:E291.Kirtane AJ, Rinaldi M, Parise H, et al. Impact of Point-of-Care Platelet Function Testing among Patients with and without Acute Coronary Syndromes Undergoing PCI with Drug-Eluting Stents: an Adapt-Des Substudy. J Am Coll Cardiol 2012;59:E291.Grosdidier C, Quilici J, Loosveld M, et al. Effect of CYP2C19*2 and *17 genetic variants on platelet response to clopidogrel and prasugrel maintenance dose and relation to bleeding complications. Am J Cardiol 2013;111(7):985-90.Grosdidier C, Quilici J, Loosveld M, et al. Effect of CYP2C19*2 and *17 genetic variants on platelet response to clopidogrel and prasugrel maintenance dose and relation to bleeding complications. Am J Cardiol 2013;111(7):985-90.Sibbing D, Schulz S, Braun S, et al. Antiplatelet effects of clopidogrel and bleeding in patients undergoing coronary stent placement. J Thromb Haemost 2010;8(2):250-6.Sibbing D, Schulz S, Braun S, et al. Antiplatelet effects of clopidogrel and bleeding in patients undergoing coronary stent placement. J Thromb Haemost 2010;8(2):250-6.Sibbing D, Steinhubl SR, Schulz S, et al. Platelet aggregation and its association with stent thrombosis and bleeding in clopidogrel-treated patients: initial evidence of a therapeutic window. J Am Coll Cardiol 2010;56:317-8.Sibbing D, Steinhubl SR, Schulz S, et al. Platelet aggregation and its association with stent thrombosis and bleeding in clopidogrel-treated patients: initial evidence of a therapeutic window. J Am Coll Cardiol 2010;56:317-8.Rangé G, Yayehd K, Belle L, et al. Thrombotic and bleeding events after coronary stenting according to clopidogrel and aspirin platelet reactivity: VerifyNow French Registry ((VERIFRENCHY). Arch Cardiovasc Dis 2014;107(4):225-35.Rangé G, Yayehd K, Belle L, et al. Thrombotic and bleeding events after coronary stenting according to clopidogrel and aspirin platelet reactivity: VerifyNow French Registry ((VERIFRENCHY). Arch Cardiovasc Dis 2014;107(4):225-35.Tantry U.S., Bliden K.P., Gurbel P.A. What is the best measure of thrombotic risks—pretreatment platelet aggregation, clopidogrel responsiveness, or post-treatment platelet aggregation? Catheter Cardiovasc Interv 2005; 66: 597-8.Tantry U.S., Bliden K.P., Gurbel P.A. What is the best measure of thrombotic risks—pretreatment platelet aggregation, clopidogrel responsiveness, or post-treatment platelet aggregation? Catheter Cardiovasc Interv 2005; 66: 597-8.Collet JP, Cuisset T, Range G, et al. Bedside monitoring to adjust antiplatelet therapy for coronary stenting. N Engl J Med 2012;367(22):2100-09.Collet JP, Cuisset T, Range G, et al. Bedside monitoring to adjust antiplatelet therapy for coronary stenting. N Engl J Med 2012;367(22):2100-09.Price MJ, Berger PB, Teirstein PS, et al. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA 2011;305(11):1097-105.Price MJ, Berger PB, Teirstein PS, et al. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA 2011;305(11):1097-105.Trenk D, Stone GW, Gawaz M, et al. A Randomised Trial of Prasugrel Versus Clopidogrel in Patients With High Platelet Reactivity on Clopidogrel After Elective Percutaneous Coronary Intervention With Implantation of Drug-Eluting Stents: Results of the TRIGGER-PCI (Testing Platelet Reactivity In Patients Undergoing Elective Stent Placement on Clopidogrel to Guide Alternative Therapy With Prasugrel) Study. J Am Coll Cardiol 2012; 59: 2159-64.Trenk D, Stone GW, Gawaz M, et al. A Randomised Trial of Prasugrel Versus Clopidogrel in Patients With High Platelet Reactivity on Clopidogrel After Elective Percutaneous Coronary Intervention With Implantation of Drug-Eluting Stents: Results of the TRIGGER-PCI (Testing Platelet Reactivity In Patients Undergoing Elective Stent Placement on Clopidogrel to Guide Alternative Therapy With Prasugrel) Study. J Am Coll Cardiol 2012; 59: 2159-64.Liang Y, Johnston M, Hirsh J, et al. Relation between clopidogrel active metabolite levels and different platelet aggregation methods in patients receiving clopidogrel and aspirin. J Thromb Thrombolysis. 2012;34:429-36.Liang Y, Johnston M, Hirsh J, et al. Relation between clopidogrel active metabolite levels and different platelet aggregation methods in patients receiving clopidogrel and aspirin. J Thromb Thrombolysis. 2012;34:429-36.Varenhorst C, James S, Erlinge D, et al. Assessment of P2Y(12) inhibition with the point-of-care device VerifyNow P2Y12 in patients treated with prasugrel or clopidogrel coadministered with aspirin. Am Heart J 2009;157:562.e1-9Varenhorst C, James S, Erlinge D, et al. Assessment of P2Y(12) inhibition with the point-of-care device VerifyNow P2Y12 in patients treated with prasugrel or clopidogrel coadministered with aspirin. Am Heart J 2009;157:562.e1-9Gurbel PA, Becker RC, Mann KG, et al. Platelet function monitoring in patients with coronary artery disease. J Am Coll Cardiol 2007;50:1822-34.Gurbel PA, Becker RC, Mann KG, et al. Platelet function monitoring in patients with coronary artery disease. J Am Coll Cardiol 2007;50:1822-34.Hazarbasanov D, Velchev V, Finkov B, et al. Tailoring clopidogrel dose according to multiple electrode aggregometry decreases the rate of ischemic complications after percutaneous coronary intervention. J Thromb Thrombolysis 2012;34(1):85-90.Hazarbasanov D, Velchev V, Finkov B, et al. Tailoring clopidogrel dose according to multiple electrode aggregometry decreases the rate of ischemic complications after percutaneous coronary intervention. J Thromb Thrombolysis 2012;34(1):85-90.Wang XD, Zhang DF, Zhuang SW, et al. Modifying clopidogrel maintenance doses according to vasodilator-stimulated phosphoprotein phosphorylation index improves clinical outcome in patients with clopidogrel resistance. Clin Cardiol 2011;34:332-8.Wang XD, Zhang DF, Zhuang SW, et al. Modifying clopidogrel maintenance doses according to vasodilator-stimulated phosphoprotein phosphorylation index improves clinical outcome in patients with clopidogrel resistance. Clin Cardiol 2011;34:332-8.Ari H, Ozkan H, Karacinar A, et al. The effect of high dose clopidogrel treatment in patients with lopidogrel resistance (the EFFICIENT trial). Int J Cardiol 2012;157:374-80.Ari H, Ozkan H, Karacinar A, et al. The effect of high dose clopidogrel treatment in patients with lopidogrel resistance (the EFFICIENT trial). Int J Cardiol 2012;157:374-80.Aradi D, Rideg O, Vorobcsuk A, et al. Justification of 150 mg clopidogrel in patients with high onclopidogrel platelet reactivity. Eur J Clin Invest 2012;42:384-92.Aradi D, Rideg O, Vorobcsuk A, et al. Justification of 150 mg clopidogrel in patients with high onclopidogrel platelet reactivity. Eur J Clin Invest 2012;42:384-92.Aradi D, Komócsi A, Price MJ, et al. Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention: systematic review and meta-analysis. Int J Cardiol 2013;167:2140-8.Aradi D, Komócsi A, Price MJ, et al. Efficacy and safety of intensified antiplatelet therapy on the basis of platelet reactivity testing in patients after percutaneous coronary intervention: systematic review and meta-analysis. Int J Cardiol 2013;167:2140-8.Straub N, Beivers A, Lenk E, et al. A model-based analysis of the clinical and economic impact of personalizing P2Y12-receptor inhibition with platelet function testing in acute coronary syndrome patients. Thromb Haemost 2014;111(2):290-9.Straub N, Beivers A, Lenk E, et al. A model-based analysis of the clinical and economic impact of personalizing P2Y12-receptor inhibition with platelet function testing in acute coronary syndrome patients. Thromb Haemost 2014;111(2):290-9.The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2014;35(37):2541-619.The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2014;35(37):2541-619.Conclusion interdisciplinary Expert Council of the Russian Society of Angiology and Vascular Surgery, Russian Scientific Society of endovascular diagnosis and treatment, the National Association for the fight against stroke, the National Scientific Society of inflammation. The role of testing platelet functional activity in the prevention of cardiovascular complications in patients receiving antiplatelet therapy. Ration Pharmacother Cardiol 2014; 10 (6): 679-87. Russian (Заключение междисциплинарного Совета Экспертов Российского общества ангиологов и сосудистых хирургов, Российского научного общества специалистов по рентгенэндоваскулярной диагностике и лечению, Национальной ассоциации по борьбе с инсультами, Национального научного общества воспаления. Роль тестирования функциональной активности тромбоцитов в профилактике сердечно-сосудистых осложнений у больных, получающих антитромбоцитарную терапию. Рациональная Фармакотерапия в Кардиологии 2014; 10(6): 679-87).Conclusion interdisciplinary Expert Council of the Russian Society of Angiology and Vascular Surgery, Russian Scientific Society of endovascular diagnosis and treatment, the National Association for the fight against stroke, the National Scientific Society of inflammation. The role of testing platelet functional activity in the prevention of cardiovascular complications in patients receiving antiplatelet therapy. Ration Pharmacother Cardiol 2014; 10 (6): 679-87. Russian (Заключение междисциплинарного Совета Экспертов Российского общества ангиологов и сосудистых хирургов, Российского научного общества специалистов по рентгенэндоваскулярной диагностике и лечению, Национальной ассоциации по борьбе с инсультами, Национального научного общества воспаления. Роль тестирования функциональной активности тромбоцитов в профилактике сердечно-сосудистых осложнений у больных, получающих антитромбоцитарную терапию. Рациональная Фармакотерапия в Кардиологии 2014; 10(6): 679-87).

The authors declare that there are no conflicts of interest present.