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Personalised antiplatelet therapy in stent thrombosis: observations from the Clopidogrel Resistance in Stent Thrombosis (CREST) registry

Personalised antiplatelet therapy in stent thrombosis: observations from the Clopidogrel Resistance in Stent Thrombosis (CREST) registry
Personalised antiplatelet therapy in stent thrombosis: observations from the Clopidogrel Resistance in Stent Thrombosis (CREST) registry
OBJECTIVE: Previous studies have demonstrated significant heterogeneity in responses to antiplatelet therapy (APT), and high residual platelet reactivity is associated with the risk of ischaemic events, including stent thrombosis (ST). The prevalence of APT hyporesponsiveness in a 'real world' registry of ST patients and the feasibility of personalising APT are reported.

PATIENTS AND SETTING: 39 consecutive patients admitted to a single regional cardiothoracic centre with definite ST were prospectively evaluated.

INTERVENTIONS: Response to aspirin and clopidogrel was measured following discharge using short thrombelastography (TEG), a rapid, well validated near patient platelet function test. Treatment modification in hyporesponders comprised an increase in aspirin dose and/or changing clopidogrel to prasugrel or ticagrelor. Short TEG was repeated following treatment modification to ensure an adequate response had been achieved.

RESULTS: 12 (31%) patients had an adequate response to both aspirin and clopidogrel, 16 (41%) were hyporesponsive to clopidogrel alone, one (3%) was hyporesponsive to aspirin alone and 10 (26%) were hyporesponsive to both aspirin and clopidogrel. Following treatment modification, an adequate response to aspirin and P2Y12 agent was achieved in 10 (91%) and 22 (85%) patients, respectively. None has presented with a further ST episode.

CONCLUSIONS: There is a high prevalence of hyporesponsiveness to APT in patients with ST. Improved APT efficacy can be achieved by tailored therapy. Short TEG is a plausible platelet function test that can be used to deliver point of care personalised APT.
706-711
Sambu, Nalyaka
7d0ba3fb-e39e-48d7-a0e4-ce249acc5980
Radhakrishnan, Ashwin
3db27dff-d225-46da-97c5-c85cec618735
Dent, Hazel
fd2608a1-fde3-4107-901a-52adcf36c7cc
Calver, Alison Louise
7d4e2a8f-ffde-41f8-a547-c1d4179d2918
Corbett, Simon
325a1edd-5325-4981-a5df-787d53f36d5e
Gray, Huon
5b0d4410-1689-40ec-b549-432c7c4d08dd
Simpson, Iain A.
9be700bd-7cae-4411-99a7-85bc4532f7d6
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Sambu, Nalyaka
7d0ba3fb-e39e-48d7-a0e4-ce249acc5980
Radhakrishnan, Ashwin
3db27dff-d225-46da-97c5-c85cec618735
Dent, Hazel
fd2608a1-fde3-4107-901a-52adcf36c7cc
Calver, Alison Louise
7d4e2a8f-ffde-41f8-a547-c1d4179d2918
Corbett, Simon
325a1edd-5325-4981-a5df-787d53f36d5e
Gray, Huon
5b0d4410-1689-40ec-b549-432c7c4d08dd
Simpson, Iain A.
9be700bd-7cae-4411-99a7-85bc4532f7d6
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4

Sambu, Nalyaka, Radhakrishnan, Ashwin, Dent, Hazel, Calver, Alison Louise, Corbett, Simon, Gray, Huon, Simpson, Iain A. and Curzen, Nick (2012) Personalised antiplatelet therapy in stent thrombosis: observations from the Clopidogrel Resistance in Stent Thrombosis (CREST) registry. Heart, 98 (9), 706-711. (doi:10.1136/heartjnl-2011-301164).

Record type: Article

Abstract

OBJECTIVE: Previous studies have demonstrated significant heterogeneity in responses to antiplatelet therapy (APT), and high residual platelet reactivity is associated with the risk of ischaemic events, including stent thrombosis (ST). The prevalence of APT hyporesponsiveness in a 'real world' registry of ST patients and the feasibility of personalising APT are reported.

PATIENTS AND SETTING: 39 consecutive patients admitted to a single regional cardiothoracic centre with definite ST were prospectively evaluated.

INTERVENTIONS: Response to aspirin and clopidogrel was measured following discharge using short thrombelastography (TEG), a rapid, well validated near patient platelet function test. Treatment modification in hyporesponders comprised an increase in aspirin dose and/or changing clopidogrel to prasugrel or ticagrelor. Short TEG was repeated following treatment modification to ensure an adequate response had been achieved.

RESULTS: 12 (31%) patients had an adequate response to both aspirin and clopidogrel, 16 (41%) were hyporesponsive to clopidogrel alone, one (3%) was hyporesponsive to aspirin alone and 10 (26%) were hyporesponsive to both aspirin and clopidogrel. Following treatment modification, an adequate response to aspirin and P2Y12 agent was achieved in 10 (91%) and 22 (85%) patients, respectively. None has presented with a further ST episode.

CONCLUSIONS: There is a high prevalence of hyporesponsiveness to APT in patients with ST. Improved APT efficacy can be achieved by tailored therapy. Short TEG is a plausible platelet function test that can be used to deliver point of care personalised APT.

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Published date: May 2012
Organisations: Human Development & Health

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Local EPrints ID: 338341
URI: http://eprints.soton.ac.uk/id/eprint/338341
PURE UUID: ce298822-5458-4f12-856a-d9ef5d152de2
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 16 May 2012 09:03
Last modified: 15 Mar 2024 03:23

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Contributors

Author: Nalyaka Sambu
Author: Ashwin Radhakrishnan
Author: Hazel Dent
Author: Alison Louise Calver
Author: Simon Corbett
Author: Huon Gray
Author: Iain A. Simpson
Author: Nick Curzen ORCID iD

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