Direct evaluation of antiplatelet therapy in coronary artery disease by comprehensive image-based profiling of circulating platelets.

Coronary artery disease (CAD) is a leading cause of death globally. Antiplatelet therapy remains crucial in preventing and treating CAD-associated thrombotic complications, but it concurrently amplifies the risk of bleeding. Unfortunately, traditional platelet function measurement methods cannot directly evaluate its efficacy and safety. Here we demonstrate comprehensive image-based profiling of circulating platelets to directly observe thrombotic conditions and assess antiplatelet therapy in CAD patients. Deep learning-based analysis of whole blood samples from 207 CAD patients revealed elevated concentrations of circulating platelet aggregates, especially in acute versus chronic coronary syndrome patients. It also indicated a regimen-dependent reduction in these concentrations upon treatment with antiplatelet drugs, thereby verifying the direct efficacy of the therapy. Notably, consistent concentrations of these aggregates were found in both venous and arterial blood, suggesting venous blood as a reliable therapy efficacy indicator, despite CAD's arterial nature. These findings support personalized and improved antiplatelet therapy in CAD management.