High-residual platelet activity despite dual antiplatelet treatment associated with subacute stent thrombosis

Abstract

<jats:title>Abstract</jats:title><jats:p>High-residual platelet activity despite the dual antiplatelet treatment with aspirin and clopidogrel is associated with major adverse cardiac events, including stent thrombosis. Acute and subacute stent thrombosis is rare, but presents itself with serious complications including high mortality and morbidity rates. Light transmittance aggregometry with specific agonists — arachidonic acid and 5-adenosin diphosphate — is still considered a standard for the assessment of platelet reactivity, besides novel methods like vasodilator-stimulated phosphoprotein phosphorylation. In our case study, we report the coincidence of high-residual platelet activity with subacute stent thrombosis despite the recommended doses of antiplatelet agents — aspirin and clopidogrel. Stent thrombosis was treated by aspiration thrombectomy, and antiplatelet treatment was modified by increasing the dose of aspirin and substituting clopidogrel with a firstgeneration thienopyridin — ticlopidin. The effect of the treatment was documented by reaching the optimal inhibition of platelet reactivity. In the 6- and 12-month follow-up, the patient presented no ischemic events.</jats:p>

High residual platelet reactivity - Does the problem persist even with new antiplatelet drugs?

“…V současné době nemáme k dispozici randomizovaná, placebem kontrolovaná data, která by potvrzovala přímou souvislost mezi vysokou reziduální destičkovou aktivitou a klinickou manifestací in-stent trombózy, na tuto souvislost však poukazují data z registrů a nerandomizovaných studií [2]. V literatuře nalezneme mnoho případů prezentujících pacienty užívající kombinaci kyseliny acetylsalicylové a clopidogrelu s časnou in-stent trombózou a záchytem vysoké reziduální destičkové aktivity [2,3], ale pouze ojedinělé případy u pacientů užívajících v kombinaci nové antiagregační léky. Nové antiagregační léky -prasugrel a ticagrelor -vedou k rychlejší, konzistentnější a silnější inhibici destiček než široce užívaný clopidogrel [4,5].…”

The effect of a leukodepletion model on the activation stage of platelets

“…It is also well known that in vitro activation of thrombocytes induce morphologic, functional, and ultrastructural changes. These changes could reduce the viability of thrombcytes, as well as their in vivo functionality and clinical efficacy [2][3][4].…”