Incidence and Clinical Impact of Dual Nonresponsiveness to Aspirin and Clopidogrel in Patients With Drug-Eluting Stents

Gori, Anna Maria; Marcucci, Rossella; Migliorini, Angela; Valenti, Renato; Moschi, Guia; Paniccia, Rita; Buonamici, Piergiovanni; Gensini, Gian Franco; Vergara, Ruben; Abbate, Rosanna; Antoniucci, David

doi:10.1016/j.jacc.2008.05.032

Cited by 188 publications

(129 citation statements)

References 27 publications

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“…61 Dual resistance to aspirin and clopidogrel at the time of drug-eluting stent implantation is associated with an 11% risk of definite or probable stent thrombosis at 6 months compared to only 2% in responders. 62 Würtz et al 63 examined the antiplatelet effects of aspirin in patients with a confirmed history of stent thrombosis compared to those without such a history and found increased platelet aggregation in patients with a history of thrombosis. Those with a history of stent thrombosis had a higher but nonsignificant fraction of immature platelet cells, suggesting that rapid platelet turnover may, in part, contribute to the heightened aspirin resistance in this population.…”

Section: History Of Stent Thrombosismentioning

confidence: 99%

Aspirin Resistance: Current Status and Role of Tailored Therapy

Grinstein

Cannon

2012

Clinical Cardiology

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Aspirin is integral in the primary and secondary prevention of coronary artery disease and acute coronary syndrome. Given the high clinical importance of aspirin in the management of coronary artery disease, much attention has been directed towards the concept of “aspirin resistance.” Unfortunately, the term aspirin resistance is ill‐defined in the literature, leading to a large variance in the reported prevalence of this phenomenon. In this review, the current understanding of aspirin resistance is discussed. Commonly used functional and diagnostic tests of platelet function, including their strengths and weakness, are reviewed. We next discuss several proposed mechanisms of aspirin resistance and special high‐risk groups at risk for aspirin treatment failure. We then discuss optimal dosing and diagnostic strategies for those populations at risk for aspirin resistance with a focus on tailored aspirin therapy for high‐risk groups. Finally, future topics of interest in the field of aspirin resistance are considered. Clin. Cardiol. 2012 doi: 10.1002/clc.22031Jonathan Grinstein has no funding, financial relationships, or conflicts of interest to disclose. Christopher P. Cannon receives research grants/support from the following companies: Accumetrics, AstraZeneca, Essentialis, GlaxoSmithKline, Merck, Regeneron, Sanofi, and Takeda. He is also on the advisory board (but funds donated to charity) for Alnylam, Bristol‐Myers Squibb, and Pfizer. He is a Clinical Advisor, equity in Automedics Medical Systems.

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Section: History Of Stent Thrombosismentioning

confidence: 99%

Aspirin Resistance: Current Status and Role of Tailored Therapy

Grinstein

Cannon

2012

Clinical Cardiology

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“…If one may accept this threshold as a reference for resistance, the incidence seems to vary about 10%-20% in stable coronary artery disease, but reaches almost 50% in acute coronary syndromes [2]. In a study on the impact of dual non-responsiveness and the drug eluting stent implantation on the incidence of stent thrombosis, this dual non-responsiveness was identified in 6% of patients [24].…”

Section: Discussionmentioning

confidence: 99%

High-residual platelet activity despite dual antiplatelet treatment associated with subacute stent thrombosis

et al. 2009

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AbstractHigh-residual platelet activity despite the dual antiplatelet treatment with aspirin and clopidogrel is associated with major adverse cardiac events, including stent thrombosis. Acute and subacute stent thrombosis is rare, but presents itself with serious complications including high mortality and morbidity rates. Light transmittance aggregometry with specific agonists — arachidonic acid and 5-adenosin diphosphate — is still considered a standard for the assessment of platelet reactivity, besides novel methods like vasodilator-stimulated phosphoprotein phosphorylation. In our case study, we report the coincidence of high-residual platelet activity with subacute stent thrombosis despite the recommended doses of antiplatelet agents — aspirin and clopidogrel. Stent thrombosis was treated by aspiration thrombectomy, and antiplatelet treatment was modified by increasing the dose of aspirin and substituting clopidogrel with a firstgeneration thienopyridin — ticlopidin. The effect of the treatment was documented by reaching the optimal inhibition of platelet reactivity. In the 6- and 12-month follow-up, the patient presented no ischemic events.

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“…Collagen binds to the GPVI and GPⅠa/Ⅱa platelet receptors inducing granule release and TXA2 generation. Recently, RPR identified by collagen aggregation in ACS patients on ASA has been reported associated with cardiovascular events [67,68] and with the polymorphism C807T predisposing to MACE [69] . Collagen induced platelet aggregation can be impaired in different condition of platelet function disorders, such as: Glanzmann's thrombastenia, abnormalities of the signal-transduction pathways caused by COX-1 deficiency (aspirin like defect) or defects of platelet granules (α and/or δ storage pool deficiency) [42] .…”

Section: Platelet Aggregation On Platelet-rich Plasmamentioning

confidence: 99%

Assessment of platelet function: Laboratory and point-of-care methods

Paniccia¹

2014

WJTM

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In the event of blood vessel damage, human platelets are promptly recruited on the site of injury and, after their adhesion, activation and aggregation, prevent blood loss with the formation of a clot. The consequence of abnormal regulation can be either hemorrhage or the development of thrombosis. Qualitative and/or quantitative defects in platelets promote bleeding, whereas the residual reactivity of platelets, despite antiplatelet therapies, play an important role in promoting arterial thrombotic complications. Platelet function is traditionally assessed to investigate the origin of a bleeding syndrome, to predict the risk of bleeding prior surgery or during pregnancy or to monitor the efficacy of antiplatelet therapy in thrombotic syndromes that, now, can be considered a new discipline. "Old" platelet function laboratory tests such as the evaluation of bleeding time and the platelet aggregation analysis in platelet-rich plasma are traditionally utilized to aid in the diagnosis and management of patients with platelet and hemostatic disorders and used as diagnostic tools both in bleeding and thrombotic diathesis in specialized laboratories. Now, new and renewed automated systems have been introduced to provide a simple, rapid assessment of platelet function including point of care methods. These new methodologies are also suitable for being used in non-specialized laboratories and in critical area for assessing platelet function in whole blood without the requirement of sample processing. Some of these methods are also beginning to be incorporated into routine clinical use and can be utilized as not only as first panel for the diagnosis of platelet dysfunction, but also for monitoring anti-platelet therapy and to potentially assess risk of both bleeding and/or thrombosis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Platelets; Method; Test; Point of care testing; Laboratory assessment; Bleeding; Thrombosis; Platelet function Core tip: This review discussed the scenario of available platelet function laboratory and point-of-care methods suitable in different clinical setting. As this matter has become of crucial importance in the bleeding management and for monitoring antiplatelet therapies, improved ability to assess platelet function in a timely and efficient manner is essential. Traditional platelet function methods, requiring a fair degree of expertise, have been limited to specialized laboratory. Many efforts have been carried out for improving platelet function assays for centralized laboratory, such as different point-of-care testing methodologies have been developed. Moreover, different guidelines and recommendations for their method standardization are growing.

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Incidence and Clinical Impact of Dual Nonresponsiveness to Aspirin and Clopidogrel in Patients With Drug-Eluting Stents

Abstract: Dual nonresponsiveness to aspirin and clopidogrel is a relatively infrequent condition that identifies patients at a very high risk of DES thrombosis or death.

Cited by 188 publications

References 27 publications

Aspirin Resistance: Current Status and Role of Tailored Therapy

Aspirin Resistance: Current Status and Role of Tailored Therapy

High-residual platelet activity despite dual antiplatelet treatment associated with subacute stent thrombosis

Assessment of platelet function: Laboratory and point-of-care methods

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