Early but not late stent thrombosis is influenced by residual platelet aggregation in patients undergoing coronary interventions

Geisler, Tobias; Zürn, Christine; Simonenko, Rostislav; Rapin, M; Kraibooj, Hassan; Kilias, Antonios; Bigalke, Boris; Stellos, Konstantinos; Schwab, Matthias; May, Andreas E.; Herdeg, Christian; Gawaz, Meinrad

doi:10.1093/eurheartj/ehp402

Cited by 97 publications

(52 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is in line with previous reports 33 and may suggest that late thrombosis is a much more complicated, multifactorial process, which is partially explained by the preliminary data demonstrating no difference of late thrombosis between CCB users vs. non-users despite persistently high OPR in the CCB users. This was not due to drug compliance between the groups because >95% of patients in all groups were strictly adherent to aspirin and clopidogrel at 6 months.…”

Section: Impact Of Interaction Between Ccbs and Clopidogrel On Early supporting

confidence: 92%

Inhibitory Interaction Between Calcium Channel Blocker and Clopidogrel - Efficacy of Cilostazol to Overcome It -

Lee

Bae

Park

et al. 2011

Circ J

View full text Add to dashboard Cite

Background:The clinical effect of, and additive measures to overcome the possible inhibitory calcium channel blocker (CCB) - clopidogrel interaction in Asian patients undergoing percutaneous coronary intervention is unknown. Methods and Results:A total of 900 Korean patients enrolled for the multicenter, prospective, randomized Influence of CILostazol-based triple antiplatelet therapy ON ischemic complication after drug-eluting stenT implantation (CILON-T) trial were divided into 4 groups depending on CCB prescription and type of anti-platelet therapy (dual [DAT] vs. triple [TAT; addition of cilostazol to DAT]) in a 2×2 factorial manner. The primary endpoint was a composite of cardiac death, non-fatal myocardial infarction and ischemic stroke at 6 months after PCI. On-treatment platelet reactivity (OPR) was assessed on VerifyNow P2Y12 assay. Concomitant CCB use increased OPR in the DAT group (mean ± SEM: 251.2±7.6 vs. 225.6±5.1; P=0.008), but not in the TAT group (214.5±9.1 vs. 203.4±5.6; P=0.294). Primary endpoint increased by use of CCB in patients with DAT (4.9% vs. 0.9%, P=0.016), but not in those with TAT (0% vs. 1.8%, P=0.346). Addition of cilostazol to DAT reduced OPR and clinical events in patients taking CCB (P=0.007 for P2Y12 reaction units; P=0.027 for thrombotic events). CCB without concomitant cilostazol use was a significant predictor of total thrombotic events.Conclusions: Concomitant use of CCB may weaken the anti-platelet effect of clopidogrel and increase subsequent thrombotic events in Asian subjects. This hazardous CCB - clopidogrel interaction may be overcome by addition of cilostazol. (Circ J 2011; 75: 2581 - 2589

show abstract

Section: Impact Of Interaction Between Ccbs and Clopidogrel On Early supporting

confidence: 92%

Inhibitory Interaction Between Calcium Channel Blocker and Clopidogrel - Efficacy of Cilostazol to Overcome It -

Lee

Bae

Park

et al. 2011

Circ J

View full text Add to dashboard Cite

show abstract

“…17) However, some patients receiving regular or even loading doses of clopidogrel develop HTPR, yet not many studies have been carried out to explore the underlying mechanisms of this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Genotype Frequencies of CYP2C19, P2Y<sub>12</sub> and GPIIIa Polymorphisms in Coronary Heart Disease Patients of Han Ethnicity, and Their Impact on Clopidogrel Responsiveness

et al. 2016

Int. Heart J.

View full text Add to dashboard Cite

“…[8][9][10][11][12][13][14] Notably, there exists a subset of patients with a hyper-response to clopidogrel who may be at increased risk of bleeding complications. 15,16) Genetic polymorphism of the CYP2C19 allele, crucial to the metabolism of clopidogrel into its active metabolite, has been implicated as a mechanism of both hyper-and hypo-response.…”

Section: -7)mentioning

confidence: 99%

Hyper-Response to Clopidogrel in Japanese Patients Undergoing Transcatheter Aortic Valve Implantation

et al. 2016

View full text Add to dashboard Cite

SummaryDual antiplatelet therapy is empirically recommended following transcatheter aortic valve implantation (TAVI). The aims of the present study were to analyze the effect of clopidogrel on platelet function and to determine the relative contribution of each CYP2C19 loss-of-function genotype undergoing TAVI.Thirty-two patients undergoing TAVI and with clopidogrel treatment were studied. All patients were treated with an Edwards SapienXT valve. Platelet reactivity was measured by the VerifyNow P2Y12 point-of-care assay at 7 days and 30 days after the procedure and a cutoff value of 95 PRU was used to identify a hyper-response of platelet reactivity. The Spartan RX TM sample-to-result point-of-care DNA testing system was used to identify CYP2C19 loss-of-function genotypes. Hyper-response of platelet reactivity was identified in 11 (34.3%) patients, although 24 (80%) were carriers of at least one CYP2C19 reduced-function allele. The PRU values did not change significantly from 7 days to 30 days after TAVI (136.7 ± 73.4 versus 150.4 ± 83.2, P = 0.13). The incidences of life-threatening bleeding, minor bleeding, and transfusion were significantly higher among the hyper-response of platelet reactivity group (27.3% versus 0%, P = 0.03, 36.4% versus 4.8%, P = 0.04, 81.8% versus 42.9%, P = 0.04, respectively).A hyper-response to clopidogrel was observed in one-third of patients undergoing TAVI and was related to bleeding events, even though 80% of the patients were carriers of the CYP2C19 reduced-function allele. (Int Heart J 2016; 57: 190-197) Key words: Platelet function tests, Antiplatelet therapy T ranscatheter aortic valve implantation (TAVI) has emerged as a viable therapeutic option for patients with severe symptomatic aortic stenosis (AS). 1,2)However, special attention should be paid to potential periprocedural and early complications, including ischemic (stroke, myocardial infarction) or bleeding (access site complication) events. 3,4) After TAVI, guidelines recommend the use of clopidogrel in addition to aspirin for a 3-to 6-month period. 5-7)While this strategy has been accepted as the usual practice following TAVI, the recommendation remains empirical and prospective controlled trials are lacking. Few data have been reported regarding the effectiveness of clopidogrel in the TAVI setting or its possible impact on adverse events.Results from previous studies in patients treated with clopidogrel have shown wide variability in platelet responsiveness, and high platelet reactivity under clopidogrel treatment has been linked to stent thrombosis and adverse cardiovascular events after coronary stenting. [8][9][10][11][12][13][14] Notably, there exists a subset of patients with a hyper-response to clopidogrel who may be at increased risk of bleeding complications. 15,16) Genetic polymorphism of the CYP2C19 allele, crucial to the metabolism of clopidogrel into its active metabolite, has been implicated as a mechanism of both hyper-and hypo-response. A loss-of-function polymorphism in CYP2C19, known as the CYP2...

show abstract

Early but not late stent thrombosis is influenced by residual platelet aggregation in patients undergoing coronary interventions

Cited by 97 publications

References 30 publications

Inhibitory Interaction Between Calcium Channel Blocker and Clopidogrel - Efficacy of Cilostazol to Overcome It -

Inhibitory Interaction Between Calcium Channel Blocker and Clopidogrel - Efficacy of Cilostazol to Overcome It -

Genotype Frequencies of CYP2C19, P2Y<sub>12</sub> and GPIIIa Polymorphisms in Coronary Heart Disease Patients of Han Ethnicity, and Their Impact on Clopidogrel Responsiveness

Hyper-Response to Clopidogrel in Japanese Patients Undergoing Transcatheter Aortic Valve Implantation

Contact Info

Product

Resources

About