Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome
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Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome. / Paarup Dridi, Nadia; Johansson, Pär I; Lønborg, Jacob T; Clemmensen, Peter; Radu, Maria D; Qayyum, Abbas; Pedersen, Frants; Kollslid, Rudi; Helqvist, Steffen; Saunamäki, Kari; Kelbæk, Henning; Jørgensen, Erik; Engstrøm, Thomas; Holmvang, Lene.
In: PLATELETS, Vol. 26, No. 6, 2015, p. 521-529.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome
AU - Paarup Dridi, Nadia
AU - Johansson, Pär I
AU - Lønborg, Jacob T
AU - Clemmensen, Peter
AU - Radu, Maria D
AU - Qayyum, Abbas
AU - Pedersen, Frants
AU - Kollslid, Rudi
AU - Helqvist, Steffen
AU - Saunamäki, Kari
AU - Kelbæk, Henning
AU - Jørgensen, Erik
AU - Engstrøm, Thomas
AU - Holmvang, Lene
PY - 2015
Y1 - 2015
N2 - AIM: To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI). There is a wide variability in the platelet reactivity to clopidogrel and HTPR has been associated with a poor prognosis.METHODS: In this observational study, 923 consecutive patients without ST-elevation myocardial infarction (STEMI) and adequately pre-treated with clopidogrel were screened for HTPR with multiple electrode aggregometry after assessment of the coronary anatomy. Patients were grouped based on their response to clopidogrel and the assigned antiplatelet strategy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis.RESULTS: HTPR was demonstrated in 237 patients (25.7%). Of these, 114 continued on conventional clopidogrel therapy, while the remaining 123 received intensified antiplatelet therapy with either double-dose clopidogrel (150 mg daily, n = 55) or the newer P2Y12-inhibitors, prasugrel or ticagrelor (n = 68) for at least 30 days after the index procedure. The median follow-up was 571 days (interquartile range, 373-746). Intensifying antiplatelet therapy reduced the rate of the composite endpoint (p < 0.001). After adjustment for potential confounders, HTPR in combination with conventional clopidogrel therapy remained independently associated with an increased risk of cardiovascular events (hazard ratio (HR), 2.92; 95% CI, 1.90-4.48), whereas intensified treatment reduced the risk to a level equivalent to that of patients exhibiting normal platelet reactivity (HR, 1.08; 95% CI, 0.59-1.99).CONCLUSION: Tailored antiplatelet therapy significantly reduced the event rate in patients exhibiting HTPR prior to PCI.
AB - AIM: To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI). There is a wide variability in the platelet reactivity to clopidogrel and HTPR has been associated with a poor prognosis.METHODS: In this observational study, 923 consecutive patients without ST-elevation myocardial infarction (STEMI) and adequately pre-treated with clopidogrel were screened for HTPR with multiple electrode aggregometry after assessment of the coronary anatomy. Patients were grouped based on their response to clopidogrel and the assigned antiplatelet strategy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis.RESULTS: HTPR was demonstrated in 237 patients (25.7%). Of these, 114 continued on conventional clopidogrel therapy, while the remaining 123 received intensified antiplatelet therapy with either double-dose clopidogrel (150 mg daily, n = 55) or the newer P2Y12-inhibitors, prasugrel or ticagrelor (n = 68) for at least 30 days after the index procedure. The median follow-up was 571 days (interquartile range, 373-746). Intensifying antiplatelet therapy reduced the rate of the composite endpoint (p < 0.001). After adjustment for potential confounders, HTPR in combination with conventional clopidogrel therapy remained independently associated with an increased risk of cardiovascular events (hazard ratio (HR), 2.92; 95% CI, 1.90-4.48), whereas intensified treatment reduced the risk to a level equivalent to that of patients exhibiting normal platelet reactivity (HR, 1.08; 95% CI, 0.59-1.99).CONCLUSION: Tailored antiplatelet therapy significantly reduced the event rate in patients exhibiting HTPR prior to PCI.
KW - Acute Coronary Syndrome/drug therapy
KW - Angina, Stable/drug therapy
KW - Clopidogrel
KW - Female
KW - Humans
KW - Male
KW - Percutaneous Coronary Intervention
KW - Platelet Activation/drug effects
KW - Platelet Aggregation Inhibitors/adverse effects
KW - Prognosis
KW - Prospective Studies
KW - Purinergic P2Y Receptor Antagonists/adverse effects
KW - Ticlopidine/adverse effects
KW - Time Factors
KW - Treatment Outcome
U2 - 10.3109/09537104.2014.948837
DO - 10.3109/09537104.2014.948837
M3 - SCORING: Journal article
C2 - 25166751
VL - 26
SP - 521
EP - 529
JO - PLATELETS
JF - PLATELETS
SN - 0953-7104
IS - 6
ER -
