Clinical implications of platelet-vessel interaction.

The interaction of platelets with endothelial and inflammatory cells might trigger atherogenesis. Different pathways are responsible for this contribution of platelets to atherogenesis. A significant association has been described between increased platelet activation and the extent of atherosclerosis. Platelet reactivity also plays a key role in determining outcomes of patients undergoing percutaneous coronary intervention (PCI). Despite dual antiplatelet therapy, platelet reactivity increases early after the procedure proportionally to the degree of vascular damage and endothelial dysfunction induced by coronary interventions, and large increases in platelet reactivity are also associated with an increased risk of periprocedural myonecrosis. The interaction between platelets and vessel wall has important clinical implications, especially in patients treated with PCI. These include the appropriate selection of antiplatelet drugs when more aggressive procedures are needed, the prognostic significance of periprocedural variations of platelet reactivity, and the correct timing for platelet function testing.