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

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.