Platelet Function Test–Guided Strategy

In this issue of Circulation: Cardiovascular Interventions , Wang et al1 publish on the real-world impact of platelet function testing where clinicians have direct access to point-of-care platelet function testing without protocol-mandated treatment strategies. Their hypothesis was that no-cost access to platelet function testing would increase treatment adjustment with P2Y12 receptor inhibitors and subsequently improve clinical outcomes of acute coronary syndrome (ACS) patients. Their conclusion is that access to no-cost platelet function testing had a modest impact on ADP receptor inhibitor selection and dosing and no impact on clinical outcome. Strikingly, switching from clopidogrel to more potent P2Y12 receptor inhibitor seemed to be independent of platelet function test results. The Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome Prospective Open Label Antiplatelet Therapy (TRANSLATE-POPS) is a relevant study as it brings into light how evidence-based medicine is translated into the real-life setting.1See Article by Wang et al This study first outlines the disproportionate relationship between knowledge and implementation into clinical practice. TRANSLATE-POPS was a prospective, cluster-randomized trial where participating centers were assigned access to no-cost platelet function testing versus usual care for ACS patients treated with PCI. Platelet function testing was performed only in two-third of patients treated in intervention sites. More importantly, treatment adjustments occurred in <20% of patients despite prior evidence that in such context at least one-third of patients would have deserved intensification of P2Y12 inhibition …