Dual antiplatelet therapy is the main pharmacological mechanism used to suppress platelet function in order to prevent thrombotic complications following percutaneous coronary angioplasty. Current studies show that the use of tailored antiplatelet therapy leads to significant clinical improvement after stent implantation. The need to individualize therapy is due to the presence of wide interindividual variations in platelet response and the differing pharmacodynamics of various P2Y12 inhibitors – clopidogrel, prasugrel, and ticagrelor. Assessment of ADP-induced platelet aggregation helps prevent both adverse ischemic events and the associated bleeding risk. The primary objective of our studies was initially to establish and overcome resistance to clopidogrel therapy with the aim of reducing adverse ischemic events. With the introduction of prasugrel and ticagrelor – medications that offer a stronger and more predictable antiplatelet effect – our focus shifted to identifying increased response and bleeding in the context of dual antiplatelet therapy, and to individualizing therapy to minimize bleeding. Our long-term experience shows that impedance aggregometry is a fast and reliable method for evaluating platelet function. The tests allow for the differentiation of patients with optimal, high, and low platelet reactivity to P2Y12 inhibitor therapy. The main conclusion from our studies is that individualizing therapy leads to the absence of ischemic events without an increased risk of hemorrhage, thereby achieving a balance between ischemic and hemorrhagic complications during treatment
