Antiplatelet resistance and the role of associated variables in stable patients treated with stenting

Abstract

IntroductionNowadays, clopidogrel and acetylsalicylic acid (ASA) have become routinely applied therapies in percutaneous coronary interventions (PCI) with stenting.AimNumerous variables can interfere with antiplatelet responsiveness, so we aimed to investigate the role of different variables associated with ASA or clopidogrel resistance in stable coronary artery disease.Material and methodsA total of 207 patients undergoing elective PCI were included in the analysis. All patients received a loading dose of clopidogrel and ASA during PCI procedure and followed by dual antiplatelet therapy. Clopidogrel and ASA resistance were measured by impedance aggregometry method.ResultsOf the patients, 19.8% had clopidogrel resistance, 18.8% had ASA resistance, 9.2% had both clopidogrel and ASA resistance, and 71.5% were responsive to both drugs. In multivariate analysis, platelet count, angiotensin receptor blocker (ARB) use, and ASA resistance were independent variables associated with clopidogrel resistance, and clopidogrel resistance was the only variable associated with ASA resistance. In differentiating whether clopidogrel resistance exists or not, optimum ASA aggregometry response cut-off values were specified, and in differentiating whether ASA resistance exists or not, optimum clopidogrel aggregometry response cut-off values were specified.ConclusionsIn this study, there was a higher incidence of low responsiveness to ASA when there was a low response to clopidogrel, and vice versa. Angiotensin receptor blocker use, platelet count, and ASA resistance were independent variables associated with clopidogrel resistance. Clopidogrel resistance was the only independent variable associated with ASA resistance. Angiotensin receptor blocker use seems to an independent risk factor for clopidogrel resistance in this study, but this result needs to be verified in other studies.

High-on-Aspirin Residual Platelet Reactivity Evaluated Using the Multiplate® Point-of-Care Device

“…A similar effect was seen for the ward where patients were admitted, with Cardiology patients being significantly more prone to be responders than those in Neurology. The results of this study regarding the association between LDL levels and aspirin response were comparable with the results of previous studies [13][14][15][16].…”

“…Beta-adrenergic receptor inhibitors (beta-blockers) have the opposite effect, increasing the chance of being a re- sponder by more than 4 times, these being in contrast with results reported by Uzun et al [13]. A similar effect was seen for the ward where patients were admitted, with Cardiology patients being significantly more prone to be responders than those in Neurology.…”

Platelet aggregation and risk of stent thrombosis or bleeding in interventionally treated diabetic patients with acute coronary syndrome

“…The study also showed that patients with higher ADP-induced platelet reactivity on clopidogrel also show diminished response to aspirin [comp. 26]. We have not, however, seen an increase in the risk of stent thrombosis in relation to arachidonic acid induced platelet reactivity alone.…”

“…Most studies examining platelet aggregation, either ADP or aspirin induced, were done in cohorts of stable coronary artery disease (CAD) patients after elective PCI procedures or in unselected all-comer populations [25, 26]. There are less studies in patients with ACS and the data on diabetic patients is mostly derived from subgroup analyses of large all-comer studies [27–30].…”

A Case of Effective Anticoagulant Therapy in a Patient With Coronary Heart Disease, Chronic Heart Failure, Atrial Fibrillation, and Left Ventricular Thrombosis

“…Наличие у пациентов хронической сердечной недостаточности (ХСН) со сниженной фракцией выброса ЛЖ, как с синусовым ритмом, так и с мерцательной аритмией, значительно повышает риск тромбоэмболических осложнений [1][2][3] из-за склонности к гиперкоагуляции и повышенному тромбообразованию. Резистентность к клопидогрелу значительно повышает риск повторного инфаркта миокарда (ИМ) и тромбоза стента [4][5][6][7], что, создавая «порочный круг», ведет к дальнейшему прогрессированию ХСН. Альтернативной является терапия новыми оральными антикоагулянтами [8][9][10][11][12], эффективность которых на примере истории болезни конкретного пациента будет рассмотрена ниже.…”