How to react to high platelet reactivity?: reply
Abstract
European Heart Journal (2008) 29, 1471-1474 LETTERS TO THE EDITOR doi:10.1093/eurheartj/ehn158 Online publish-ahead-of-print 15 April 2008 How to react to high platelet reactivity? With interest we read the article on the prognostic signiï¬cance of high platelet reactivity as measured with the VerifyNow P2Y12 assay for atherothrombotic events after coronary stenting.1 We compliment the authors on their methodology. In contrast to many previous reports, they did not use a prospectively chosen cut-off value with subsequent clinical follow-up. Inherent to ROC analysis, the observed cut-off value in the present report is based on the optimal clinical discrimination between higher and lower risk patients. We believe that this is an essential step that should also be taken in other studies investigating platelet reactivity in relation to thrombotic events. Presently, no clinically based cut-off values are available for patients on (dual) antiplatelet therapy, and no test has been consistently validated in prospective studies on clinical events. Unfortunately, the cut-offs in most of the previous reports are arbitrarily chosen, supplied by the manufacturer, or even reï¬ect values derived in subjects not using antiplatelet therapy. The ï¬nding that high platelet reactivity on the VerifyNow P2Y12 assay is related to an increased risk of thrombotic