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Point-of-care platelet function assays demonstrate reduced responsiveness to clopidogrel, but not aspirin, in patients with Drug-Eluting Stent Thrombosis whilst on dual antiplatelet therapy

Point-of-care platelet function assays demonstrate reduced responsiveness to clopidogrel, but not aspirin, in patients with Drug-Eluting Stent Thrombosis whilst on dual antiplatelet therapy
Point-of-care platelet function assays demonstrate reduced responsiveness to clopidogrel, but not aspirin, in patients with Drug-Eluting Stent Thrombosis whilst on dual antiplatelet therapy
Background

To test the hypothesis that point-of-care assays of platelet reactivity would demonstrate reduced response to antiplatelet therapy in patients who experienced Drug Eluting Stent (DES) ST whilst on dual antiplatelet therapy compared to matched DES controls. Whilst the aetiology of stent thrombosis (ST) is multifactorial there is increasing evidence from laboratory-based assays that hyporesponsiveness to antiplatelet therapy is a factor in some cases.

Methods

From 3004 PCI patients, seven survivors of DES ST whilst on dual antiplatelet therapy were identified and each matched with two patients without ST. Analysis was performed using (a) short Thrombelastogram PlateletMapping™ (TEG) and (b) VerifyNow Aspirin and P2Y12 assays. TEG analysis was performed using the Area Under the Curve at 15 minutes (AUC15) as previously described.

Results

There were no differences in responses to aspirin. There was significantly greater platelet reactivity on clopidogrel in the ST group using the Accumetrics P2Y12 assay (183 ± 51 vs. 108 ± 31, p = 0.02) and a trend towards greater reactivity using TEG AUC15 (910 ± 328 vs. 618 ± 129, p = 0.07). 57% of the ST group by TEG and 43% of the ST cases by Accumetrics PRU had results > two standard deviations above the expected mean in the control group.

Conclusion

This study demonstrates reduced platelet response to clopidogrel in some patients with DES ST compared to matched controls. The availability of point-of-care assays that can detect these responses raises the possibility of prospectively identifying DES patients at risk of ST and manipulating their subsequent risk.
function, methods, abstract, risk, therapy, analysis, hypothesis, aspirin, responses
1477-9560
1-6
Hobson, Alex R.
fb159129-d057-45ea-9351-19920a77993e
Petley, Graham
4f2da40b-3c7b-4adc-b75c-e24e62bb1cf0
Morton, Geraint
fb5d4d37-ba0e-480c-9ac8-f130ef6505e1
Dawkins, Keith D.
a67f577d-8101-45be-9460-894fbc0a74db
Curzen, Nick P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Hobson, Alex R.
fb159129-d057-45ea-9351-19920a77993e
Petley, Graham
4f2da40b-3c7b-4adc-b75c-e24e62bb1cf0
Morton, Geraint
fb5d4d37-ba0e-480c-9ac8-f130ef6505e1
Dawkins, Keith D.
a67f577d-8101-45be-9460-894fbc0a74db
Curzen, Nick P.
70f3ea49-51b1-418f-8e56-8210aef1abf4

Hobson, Alex R., Petley, Graham, Morton, Geraint, Dawkins, Keith D. and Curzen, Nick P. (2008) Point-of-care platelet function assays demonstrate reduced responsiveness to clopidogrel, but not aspirin, in patients with Drug-Eluting Stent Thrombosis whilst on dual antiplatelet therapy. Thrombosis Journal, 6 (1), 1-6. (doi:10.1186/1477-9560-6-1). (PMID:18312665)

Record type: Article

Abstract

Background

To test the hypothesis that point-of-care assays of platelet reactivity would demonstrate reduced response to antiplatelet therapy in patients who experienced Drug Eluting Stent (DES) ST whilst on dual antiplatelet therapy compared to matched DES controls. Whilst the aetiology of stent thrombosis (ST) is multifactorial there is increasing evidence from laboratory-based assays that hyporesponsiveness to antiplatelet therapy is a factor in some cases.

Methods

From 3004 PCI patients, seven survivors of DES ST whilst on dual antiplatelet therapy were identified and each matched with two patients without ST. Analysis was performed using (a) short Thrombelastogram PlateletMapping™ (TEG) and (b) VerifyNow Aspirin and P2Y12 assays. TEG analysis was performed using the Area Under the Curve at 15 minutes (AUC15) as previously described.

Results

There were no differences in responses to aspirin. There was significantly greater platelet reactivity on clopidogrel in the ST group using the Accumetrics P2Y12 assay (183 ± 51 vs. 108 ± 31, p = 0.02) and a trend towards greater reactivity using TEG AUC15 (910 ± 328 vs. 618 ± 129, p = 0.07). 57% of the ST group by TEG and 43% of the ST cases by Accumetrics PRU had results > two standard deviations above the expected mean in the control group.

Conclusion

This study demonstrates reduced platelet response to clopidogrel in some patients with DES ST compared to matched controls. The availability of point-of-care assays that can detect these responses raises the possibility of prospectively identifying DES patients at risk of ST and manipulating their subsequent risk.

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More information

Published date: 29 February 2008
Keywords: function, methods, abstract, risk, therapy, analysis, hypothesis, aspirin, responses
Organisations: Faculty of Health Sciences, Human Development & Health

Identifiers

Local EPrints ID: 383363
URI: http://eprints.soton.ac.uk/id/eprint/383363
ISSN: 1477-9560
PURE UUID: 6f14fc62-cd72-4f95-97c8-5f50b6f3d79f
ORCID for Graham Petley: ORCID iD orcid.org/0000-0002-3295-0444
ORCID for Nick P. Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 27 Oct 2015 15:25
Last modified: 15 Mar 2024 03:23

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Contributors

Author: Alex R. Hobson
Author: Graham Petley ORCID iD
Author: Geraint Morton
Author: Keith D. Dawkins
Author: Nick P. Curzen ORCID iD

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