Stent Thrombosis Is Associated With an Impaired Response to Antiplatelet Therapy

Wenaweser, Peter; Dörffler‐Melly, Janine; Imboden, Katja; Windecker, Stephan; Togni, Mario; Meier, Bernhard; Haeberli, André; Hess, Otto M.

doi:10.1016/j.jacc.2005.01.058

Cited by 245 publications

(178 citation statements)

References 16 publications

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“…In a study of 23 patients, Wenaweser et al found that aspirin and clopidogrel resistance, but not clopidogrel resistance alone, predicted a history of stent thrombosis. 11 In contrast, Gurbel et al reported in the CREST study of 20 subjects with stent thrombosis, a higher mean platelet reactivity to ADP as compared to matched controls. 12 Triple therapy with aspirin and a thienopyridine (clopidogrel or ticlopidine) plus clilostrazol, a phosphodiesterase III inhibitor, has been reported to lower rates of stent thrombosis as compared to aspirin and thienopyridine alone (0.3% vs. 0.8%, respectively, OR 0.12).…”

Section: Discussionmentioning

confidence: 89%

A case report of simultaneous thrombosis of two coronary artery stents in association with clopidogrel resistance

Lee

Dunn

Marshall

et al. 2007

Clinical Cardiology

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SummaryDespite aggressive antiplatelet therapy in the setting of PCI, the incidence of acute stent thrombosis remains approximately 0.5-2%. We report a patient with simultaneous thrombosis of two drug-eluting coronary artery stents, suggesting a systemic thrombotic state. Evaluation by optical platelet aggregometry revealed clopidogrel resistance, which was overcome at a higher drug dose. We aim to highlight the potential utility of platelet function analysis to guide therapy for patients in whom inadequate antiplatelet therapy may have catastrophic clinical outcomes.

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Section: Discussionmentioning

confidence: 89%

A case report of simultaneous thrombosis of two coronary artery stents in association with clopidogrel resistance

Lee

Dunn

Marshall

et al. 2007

Clinical Cardiology

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“…Clopidogrel response varies a lot in patients but also in healthy subjects mainly due to genetic differences in metabolising enzymes or drug-drug interactions (50)(51)(52). Several studies have shown that the degree of ADP-induced platelet aggregation post-PCI correlates with subsequent ischaemic events and death, and data suggest that relative hyporesponsiveness to clopidogrel increases the risk of stent thrombosis (18,(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65). Furthermore, several trials revealed that various therapeutic manipulations, including the novel thienopyridine prasugrel, improved antiplatelet response (60).…”

Section: Clinical Focusmentioning

confidence: 99%

Assessment of platelets and the endothelium in patients presenting with acute coronary syndromes – is there a future?

Derhaschnig¹,

Jilma²

2009

Thromb Haemost

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“…Impaired response to antiplatelet therapy with aspirin using optical aggregometry has been demonstrated in patients with ST. Additional treatment with clopidogrel was not able to overcome this impaired response. 59 Resistance to clopidogrel and failure to metabolize clopidogrel to its active metabolite has also played a role in ST. 60 However, currently, there is no confirmed association between low responsiveness to clopidogrel and thrombotic events. The optimal level of clopidogrel-induced platelet inhibition, which will correlate quantitatively with clopidogrel's ability to prevent atherothrombotic events, is still lacking.…”

Section: Urgent Surgical Proceduresmentioning

confidence: 99%

Brief review: Coronary drug-eluting stents and anesthesia

Dalal

Stanlies

Souza

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Anesthesiologists managing patients with drug-eluting stents (DES) face the challenge of balancing the risks of bleeding vs perioperative stent thrombosis (ST). This article reviews DES and the influence of antiplatelet medications related to their use. A perioperative management algorithm is suggested. Novel P2Y12 antagonists currently under investigation, including cangrelor and prasugrel are considered, as well as their potential role in modification of perioperative cardiovascular risks and management of patients with DES.Source: A PubMed search of the relevant literature over the period 1985-2005 was undertaken using the terms "drug-eluting stent", "coronary artery stent", "bare metal stent", "antiplatelet medication", "aspirin", "clopidogrel."Principal findings: Delayed re-endothelialization may render both sirolimus-eluting and paclitaxel-eluting stents susceptible to thrombosis for a longer duration than bare metal stents. Stent thrombosis may be associated with resistance to antiplatelet medication. In patients with a DES, a preoperative cardiology consultation is essential. Elective surgery should be postponed if the duration between DES placement and noncardiac surgery is less than six months. For semi-emergent procedures, both aspirin and clopidogrel should be continued during surgery unless clearly contraindicated by the nature of the surgery. If the risk of bleeding is high, then modification of antiplatelet medications should be considered on a case-by-case basis. Conclusion: A profound increase in the number of patients with DES requires anesthesiologists to be familiar with their associated antiplatelet medications, and strategies for risk modification of ST and possible hemorrhagic complications in the perioperative setting. Objectif

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Stent Thrombosis Is Associated With an Impaired Response to Antiplatelet Therapy

Cited by 245 publications

References 16 publications

A case report of simultaneous thrombosis of two coronary artery stents in association with clopidogrel resistance

A case report of simultaneous thrombosis of two coronary artery stents in association with clopidogrel resistance

Assessment of platelets and the endothelium in patients presenting with acute coronary syndromes – is there a future?

Brief review: Coronary drug-eluting stents and anesthesia

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