Clopidogrel Responsiveness Regardless of the Discontinuation Date Predicts Increased Blood Loss and Transfusion Requirement After Off-Pump Coronary Artery Bypass Graft Surgery

Kwak, Young Lan; Kim, Jong Chan; Choi, Yong Seon; Yoo, Koo Han; Song, Young Goo; Shim, Jæ Kwang

doi:10.1016/j.jacc.2010.03.108

Cited by 122 publications

(94 citation statements)

References 31 publications

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“…34 Thrombin-induced platelet-fibrin clot strength (MA thrombin ) measured by thrombelastography, an indicator of hypercoagulability, has been shown to be associated with post-PCI ischemic events occurrence. 35 Interestingly, Korean patients with coronary artery disease appeared to have relatively low levels of MA thrombin compared with Western population (mean, 61.5 versus Ϸ68 mm), 35,36 suggesting that thrombin-mediated hemostasis plays a little role in atherothrombosis among East Asians. 37 Low level of prothrombotic potency in East Asian may suggest a underlying mechanism to explain more bleeding tendency in this ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Effect of CYP2C192* and *3 Loss-of-Function Alleles on Platelet Reactivity and Adverse Clinical Events in East Asian Acute Myocardial Infarction Survivors Treated With Clopidogrel and Aspirin

Jeong

Tantry

Kim

et al. 2011

Circ: Cardiovascular Interventions

116

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Background-As compared with whites, East Asians more often carry the cytochrome P450 (CYP) 2C19 loss-of-function (LOF) allele with the CYP2C19*3 variant. The influence of the CYP2C19 LOF alleles (*2 and *3) on clopidogrel response and clinical outcomes in East Asians with acute myocardial infarction (AMI) has not been reported. We sought to evaluate the effect of the CYP2C19 variants on clopidogrel pharmacodynamics and long-term prognosis in these patients. Methods and Results-Patients who survived an AMI (nϭ266) were enrolled in a single-center registry. Predischarge platelet reactivity was assessed with light transmittance aggregometry and the VerifyNow P2Y12 assay; the CYP2C19*2, *3, *17 and ABCB1 3435CϾT variants were determined. The primary clinical end point was the composite of cardiovascular death, nonfatal MI, and ischemic stroke. The median exposure to clopidogrel was 21 months (interquartile range, 13-29). The ABCB1 3435CϾT was not related to clopidogrel response or cardiovascular events. Carriage of the CYP2C19 LOF variant allele was relatively high (60.9%, nϭ162; *2/*17ϭ2, *3/*17ϭ1, *1/*2ϭ96, *1/*3ϭ29, *2/*2ϭ20, and *2/*3ϭ14). Platelet reactivity increased proportionally according to the number of the CYP2C19 LOF alleles. In a multivariate regression analysis, the risk of high on-treatment platelet reactivity (HPR) increased depending on the number of CYP2C19 LOF allele [1 LOF allele; odds ratio (OR), 1.

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Section: Discussionmentioning

confidence: 99%

Effect of CYP2C192* and *3 Loss-of-Function Alleles on Platelet Reactivity and Adverse Clinical Events in East Asian Acute Myocardial Infarction Survivors Treated With Clopidogrel and Aspirin

Jeong

Tantry

Kim

et al. 2011

Circ: Cardiovascular Interventions

116

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“…Preoperative strong antiplatelet-drug-induced inhibition is an important contributory factor that is correlated with increased postoperative bleeding and platelet transfusion requirement [2,[25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet therapy before cardiac surgery

Demertzis¹,

Cassina²,

Casso³

2016

Cardiovasc Med

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“…The surgery was successful, clopidogrel and aspirin were restarted eight hours later with loading doses, and the patient did not experience any thrombotic or bleeding events during the perioperative period [19]. Small studies have shown that adenosine diphosphate aggregometry, multiple electrode platelet aggregometry, and thromboelastography platelet mapping may be able to predict bleeding risks for patients receiving coronary artery bypass grafts (CABG) [20][21][22]. However, one of those studies showed that the point-of-care tests Platelet Function Analyzer 100 and Platelet Works were not predictive of which patients receiving CABG would bleed [20].…”

Section: Discussionmentioning

confidence: 99%

Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

Lalama¹

2011

J Clinic Experiment Cardiol

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Purpose: To describe how VerifyNow P2Y 12 testing for clopidogrel response is being utilized at a community hospital.Methods: A retrospective chart review was conducted at a 411-bed community hospital in patients who tested positive for poor clopidogrel response.Results: There were 95 positive P2Y 12 tests evaluated in this study. Positive P2Y 12 tests were obtained 40.0% of the time for cardiovascular indications, 28.4% for neurologic indications, 1.1% for hematologic indications, and 30.5% were obtained to evaluate patients prior to surgery. The medication regimens of 38.8% of patients did not change as a result of a positive test for poor clopidogrel response. The clopidogrel dose was increased in 16.3% of patients, and clopidogrel was discontinued in 10.2% of patients positive for poor clopidogrel response not undergoing surgical evaluation. Rehospitalization rates of non-surgical patients for recurrent thrombosis or bleeding at 90 days were highest for patients who had an additional antiplatelet agent or anticoagulant added due to poor clopidogrel response. The lowest rehospitalization rate was seen in patients switched to an alternative agent. Conclusions:The most common findings after a positive P2Y 12 test in non-surgical patients were no change in therapy and increasing the dose of clopidogrel. Adding an additional antiplatelet agent or anticoagulant was associated with the highest risk of rehospitalization.

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Clopidogrel Responsiveness Regardless of the Discontinuation Date Predicts Increased Blood Loss and Transfusion Requirement After Off-Pump Coronary Artery Bypass Graft Surgery

Cited by 122 publications

References 31 publications

Effect of CYP2C192* and *3 Loss-of-Function Alleles on Platelet Reactivity and Adverse Clinical Events in East Asian Acute Myocardial Infarction Survivors Treated With Clopidogrel and Aspirin

Effect of CYP2C192* and *3 Loss-of-Function Alleles on Platelet Reactivity and Adverse Clinical Events in East Asian Acute Myocardial Infarction Survivors Treated With Clopidogrel and Aspirin

Antiplatelet therapy before cardiac surgery

Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

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Clopidogrel Responsiveness Regardless of the Discontinuation Date Predicts Increased Blood Loss and Transfusion Requirement After Off-Pump Coronary Artery Bypass Graft Surgery

Cited by 122 publications

References 31 publications

Effect of CYP2C19*2 and *3 Loss-of-Function Alleles on Platelet Reactivity and Adverse Clinical Events in East Asian Acute Myocardial Infarction Survivors Treated With Clopidogrel and Aspirin

Effect of CYP2C19*2 and *3 Loss-of-Function Alleles on Platelet Reactivity and Adverse Clinical Events in East Asian Acute Myocardial Infarction Survivors Treated With Clopidogrel and Aspirin

Antiplatelet therapy before cardiac surgery

Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

Contact Info

Product

Resources

About

Effect of CYP2C192* and *3 Loss-of-Function Alleles on Platelet Reactivity and Adverse Clinical Events in East Asian Acute Myocardial Infarction Survivors Treated With Clopidogrel and Aspirin

Effect of CYP2C192* and *3 Loss-of-Function Alleles on Platelet Reactivity and Adverse Clinical Events in East Asian Acute Myocardial Infarction Survivors Treated With Clopidogrel and Aspirin