P2Y12 receptor antagonists are widely used to prevent thrombotic events in acute coronary syndromes (ACS) patients after undergoing percutaneous coronary intervention (PCI). Due to the variability of antiplatelet responsiveness, high on-treatment platelet reactivity (HTPR) has been observed to be related to cardiovascular adverse events in the patients treated with a classical P2Y12 receptor antagonist, clopidogrel. New P2Y12 receptor antagonists, such as prasugrel and ticagrelor, exert better antithrombotic effect than clopidogrel; however, higher efficacy, which is reflected by low on-treatment platelet reactivity (LTPR), increases the risk of bleeding events. How to balance the risk of thrombosis and bleeding to achieve individualized antiplatelet therapy has become an important clinical challenge. Evidence has shown that platelet reactivitcy (PR) is associated with ischemia and hemorrhage events. Therapeutic windows based on the platelet function test (PFT) will contribute to individualized antiplatelet therapy. The present review focused on the advance of PFT in individualized antiplatelet therapy with P2Y12 receptor antagonists.