Personalized antiplatelet therapy: a scoping review on the role of platelet function testing and genotyping in acute coronary syndrome

Acute coronary syndrome (ACS) remains a leading cause of global morbidity and mortality, often managed with antiplatelet therapy. However, variability in patient response due to comorbidities, genetic polymorphisms, and resistance to antiplatelet agents creates challenges in optimizing treatment. The scoping review was conducted using Arksey and O'Malley's five-step framework to identify facilitators and challenges influencing the use of Platelet Function Test (PFT) and genotype-guided antiplatelet therapy for ACS. PubMed, Embase, and Scopus were utilized for identifying the relevant articles published between 2010 and 2025. A total of 346 studies was included, with sample sizes ranging from 13 to 10,048 patients. The included studies showed heterogeneity in study design, sample size, follow-ups, PFT techniques and in outcomes. The articles had predominantly male patients with various comorbidities. The PFTs identified included VerifyNow, light transmission aggregometry (LTA), vasodilator-stimulated phosphoprotein (VASP), multiplate, thromboelastography (TEG) etc. The facilitating factors for PFT included risk stratification for bleeding and ischemic events and treatment adjustments in high-risk groups. Whereas the key challenges identified were lack of assay standardization, discordance between test results, and variability across testing modalities. Although the association between treatment response and genetic polymorphisms were frequently reported, evidence for clinical outcome remains variable and uncertain. Existing evidence shows that PFT and genotyping may provide significant findings for tailoring antiplatelet therapy in ACS. However the heterogeneity and practical challenges limit their routine use. Further, well-designed outcome driven studies and standardised protocols are required to define their role in precision guided therapy for ACS management.