Platelet reactivity pattern in a patient with multiple pharmacogenetic factors of reduced clopidogrel efficiency.

Samardžić, Jure; Božina, Nada; Škorić, Boško; Krpan, Miroslav; Pašalić, Marijan; Ganoci, Lana; Petričević, Mate; Miličić, Davor

doi:10.15836/ccar.2015.206

Cited by 1 publication

(4 citation statements)

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“…Routine measurement of platelet reactivity and thorough monitoring of patients with clopidogrel resistance is certainly warranted [21]. It seems that longitudinal follow up based on drug specific platelet function testing that would lead to periodical APT adjustments, rather than adjustments performed in single time point, should be an integral part of a personalized APT administration management [22].…”

Section: Postoperative Considerationsmentioning

confidence: 99%

“…Again, longitudinal follow up with subsequent dose regimen adjustments is rational. Our working group recently found that serial clopidogrel dose adjustments targeted after platelet function testing improve outcomes of patients undergoing percutaneous coronary intervention with high on-treatment platelet reactivity [22]. Although this approach has not specifically been validated in post-CAS setting, it sounds reasonable to implement a longitudinal follow up of platelet function in a personalized concept of APT management.…”

Section: Postoperative Considerationsmentioning

confidence: 99%

“…If values of drug specific platelet function tests are above the upper bound value of a pre-defined therapeutic window, it is very important to: 1) increase the drug dose if possible or administer additional antiplatelet drug, and 2) provide platelet function testing longitudinal follow up [22]. Both high "on treatment" residual platelet reactivity and pronounced platelet inhibition may be transient phenomenons requiring temporary adjustments.…”

Section: Implications For Everyday Clinical Practicementioning

confidence: 99%

“…Both high "on treatment" residual platelet reactivity and pronounced platelet inhibition may be transient phenomenons requiring temporary adjustments. Thus, using longitudinal follow up it is possible to continuously keep platelet function within the predefined therapeutic range [22]. The lack of longitudinal follow up may result in a switch from the risk of ischemic events to the risks of bleeding events and vice versa.…”

Section: Implications For Everyday Clinical Practicementioning

confidence: 99%

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Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

Petričević

Miličić

White

et al. 2015

J Thromb Thrombolysis

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administration/discontinuation management. Despite emerging evidence on the widespread variability in platelet inhibitory response to APT, numerous PFT devices and heterogeneity in reporting study results hamper pooling of the evidence which in turn results with a lack of consensus in "on treatment" platelet reactivity associated with ischemic and bleeding events in perioperative phase. MethodsThe literature on multiple electrode aggregometry (Multiplate® ; Roche Diagnostics, Mannheim, Germany) in coronary artery disease patients was reviewed systematically. Based on the evidence evaluating the relationship between "drug specific" PFT and bleeding or adverse ischemic events, we sought to define therapeutic window for the most commonly administered antiplatelet drugs such as aspirin (ASPI test) and adenosine-diphosphate receptor blockers (ADP test). ResultsPreoperatively, APT administration was primarily focused to avoid bleeding complications.ASPI test value of 20 AUC and ADP test value of <73 AUC were set as cut-off values that delineate bleeding tendency. Postoperatively, "therapeutic window" was set to avoid both 3 bleeding and adverse ischemic events. Therapeutic ranges were as follows: 20AUC

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Section: Postoperative Considerationsmentioning

confidence: 99%

Section: Postoperative Considerationsmentioning

confidence: 99%

Section: Implications For Everyday Clinical Practicementioning

confidence: 99%

Section: Implications For Everyday Clinical Practicementioning

confidence: 99%

See 2 more Smart Citations