Sub-acute stent thrombosis secondary to ticagrelor resistance—Myth or reality!!

Jariwala, Pankaj; Bhatia, Hemanshu; Kumar, Edla Arjun Padma

doi:10.1016/j.ihj.2017.10.012

Cited by 9 publications

(9 citation statements)

References 5 publications

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“…Also, the asymptomatic status of the patient after his COVID-19 illness makes this possibility highly unlikely. The occurrence of stent thrombosis due to ticagrelor resistance has been reported rarely in the literature [ 13 - 16 ], and could have been contributory toward the development of stent thrombosis in our case, but the occurrence of true resistance to ticagrelor therapy is still debated [ 17 ]. Nevertheless, we kept this possibility in mind and ticagrelor was switched to prasugrel.…”

Section: Discussionmentioning

confidence: 95%

Double Whammy: Subacute Stent Thrombosis While Being Adherent to Dual Antiplatelet Therapy Including Ticagrelor, Followed by Multiple Coronary Artery Aneurysms in a COVID-19 Patient

Sidhu¹,

Kaur²

2022

Cureus

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Coronavirus disease 2019 , although predominantly a respiratory illness, can have important cardiovascular implications, which include the development of myocardial injury/myocarditis, acute coronary syndromes, arrhythmias, pericarditis, and the occurrence of arterial and venous thrombosis. We describe a rare case of a middle-aged COVID-19 patient who developed sub-acute stent thrombosis after implantation of second-generation drug-eluting stents (DES) despite being adherent to dual antiplatelet therapy including ticagrelor and who subsequently developed multiple coronary artery aneurysms within a few weeks of the DES implantation.

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Section: Discussionmentioning

confidence: 95%

Double Whammy: Subacute Stent Thrombosis While Being Adherent to Dual Antiplatelet Therapy Including Ticagrelor, Followed by Multiple Coronary Artery Aneurysms in a COVID-19 Patient

Sidhu¹,

Kaur²

2022

Cureus

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“…Two weeks after initiating DAPT with ticagrelor, the patient was found to have subacute stent thrombosis, per angiography, after symptoms of acute chest discomfort. A bolus of eptifibatide was given for treatment, and the patient was discharged on ticagrelor, 90 mg twice daily, and aspirin, 75 mg daily 19 . Platelet function testing was absent.…”

Section: Discussionmentioning

confidence: 99%

“…A bolus of eptifibatide was given for treatment, and the patient was discharged on ticagrelor, 90 mg twice daily, and aspirin, 75 mg daily. 19 Platelet function testing was absent. Olechowski et al reported 3 cases of ticagrelor resistance in patients with ACS receiving DAPT following percutaneous coronary intervention.…”

Section: Discussionmentioning

confidence: 99%

Vorapaxar as an Alternative for Ticagrelor Resistance in Neuroendovascular Intervention

Mamaril-Davis

Aguilar‐Salinas

Brasiliense

et al. 2021

SVIN

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Background Perioperative dual‐antiplatelet therapy for flow diversion limits thromboembolic complications. However, resistance to dual‐antiplatelet therapy medications remains a concern for neuroendovascular intervention. To date, there is no standardized approach for resistance to ADP receptor antagonists. Methods We report a case of ticagrelor resistance for flow diversion of an intracranial aneurysm treated with vorapaxar, as well as a narrative review of the literature for previous cases of ticagrelor resistance. Results Flow diversion with the Pipeline embolization device was deployed for a left internal carotid artery blister aneurysm and bilateral internal carotid artery dissecting pseudoaneurysms. The patient had 3 thromboembolic complications while on dual‐antiplatelet therapy with ticagrelor or prasugrel, leading to transition of antiplatelet therapy to vorapaxar. At 84 days follow‐up, the patient was fully recovered with complete occlusion of the aneurysms. Conclusion Our case suggests that vorapaxar is a promising alternative for patients with ticagrelor resistance in flow diversion–treated intracranial aneurysms. High‐quality randomized controlled trials are needed to elucidate the safety and efficacy of vorapaxar in neuroendovascular procedures.

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“…For example, in a sub-analysis of the randomized GRAVITAS (Gauging Responsiveness with a Verify Now P2Y12 assay: Impact on Thrombosis and Safety) study [ 24 ], HPR (defined as >208 P2Y12 reaction units when examined with a point-of-care Verify Now ® assay at 12 to 24 h after PCI) was connected with a higher risk of adverse ischemia at 60 days and at 6 months (at 60 days: hazard ratio [HR]: 0.18; 95% confidence interval [CI]: 0.04–0.79; p = 0.02; at 6 months: HR: 0.43; 95% CI: 0.23–0.82; p = 0.01). Additionally, HPR remains independently associated with adverse vascular events (including stent thrombosis) also in individuals treated with novel P2Y12 ADP receptor blockers with stronger platelet inhibition, such as prasugrel and ticagrelor [ 28 , 29 , 30 ]. Summarizing the data, HPR despite oral antiplatelet agents has been consistently connected with the risk of adverse ischemia; thus identifying individuals with insufficient antiplatelet therapy response might help in preventing these possibly fatal events.…”

Section: Viscoelastic Hemostatic Assays and Platelet Function Testmentioning

confidence: 99%

Viscoelastic Hemostatic Assays and Platelet Function Testing in Patients with Atherosclerotic Vascular Diseases

et al. 2021

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Platelets play crucial role in acute vascular atherosclerotic diseases, including myocardial infarction and stroke. Additionally, platelet aggregation is a key target of antiplatelet agents, forming the keystone of pharmacotherapy of various atherosclerotic cardiovascular diseases. Thromboelastography and thromboelastometry, representing currently available viscoelastic hemostatic assays (VHA), are designed as whole blood, real-time analyzers of clot formation and clot resolution. These assays could, in theory, overcome some limitations of currently available platelet function testing assays. This article reviews the current experience with the use of VHA for platelet function testing and for monitoring of the response to antiplatelet therapy.

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Sub-acute stent thrombosis secondary to ticagrelor resistance—Myth or reality!!

Cited by 9 publications

References 5 publications

Double Whammy: Subacute Stent Thrombosis While Being Adherent to Dual Antiplatelet Therapy Including Ticagrelor, Followed by Multiple Coronary Artery Aneurysms in a COVID-19 Patient

Double Whammy: Subacute Stent Thrombosis While Being Adherent to Dual Antiplatelet Therapy Including Ticagrelor, Followed by Multiple Coronary Artery Aneurysms in a COVID-19 Patient

Vorapaxar as an Alternative for Ticagrelor Resistance in Neuroendovascular Intervention

Viscoelastic Hemostatic Assays and Platelet Function Testing in Patients with Atherosclerotic Vascular Diseases

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