Prediction of high risk of non-adherence to antiplatelet treatment

Self Cite

Background. Many reports have demonstrated excessive variability in response to clopidogrel, the most commonly used P2Y12 receptor antagonist. Clopidogrel resistant patients are at increased risk of cardiovascular (CV) events. Prasugrel is a new P2Y12 inhibitor that provides greater and faster platelet inhibition and reduces CV events more effectively than clopidogrel. The aim of this study was to evaluate the variability and efficacy of prasugrel antiplatelet activity in patients presenting with acute coronary syndrome (ACS). Materials and methods. The study was designed as a prospective, single-center, non-randomized, observational trial. Platelet reactivity (PR) was assessed with the VeryfyNow assay three times during hospitalization in forty-two patients undergoing percutaneous coronary intervention (PCI) for ACS and treated with standard doses of prasugrel. Results. Platelet aggregation with prasugrel displayed relatively high variability. The platelet aggregation was lowest on the 3 rd day of the treatment at 4 p.m. and was significantly different from the measurements obtained on the 3 rd and 4 th day in the morning (6.0 v. 8.5 U; p = 0.0005 and 6.0 v. 36.5 U; p < 0.00001, respectively), with the latter two differing significantly from each other (p = 0.002). All participants were successfully treated with prasugrel achieving PR < 208 PRU in each measurement, whereas 42.9-80.9% (depending on sampling point) of patients presented very low platelet activity. The subgroups of stable and persistent low PR included a higher percentage of active smokers (73.3 v. 40.7%; p = 0.04 and 80.0 v. 43.8%; p = 0.04, respectively). Conclusions. Prasugrel treatment is associated with high variability of PR. Nonetheless, prasugrel is a highly effective antiplatelet drug. Active smoking may predispose to strong and stable on-prasugrel platelet inhibition.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Variability of prasugrel antiplatelet effect in patients with acute coronary syndrome

Kasprzak

Molska²,

Obońska³

et al. 2015

Self Cite

“…Nurse judgement of low discharge readiness was associated with a six-to nine-fold increase in readmission risk; however, patient self-assessment was associated neither with readmission nor with visits in emergency department [19]. Patient self-assessment is a purely subjective assessment, while nurse evaluation is more objective [20,21]. Such an approach was applied in RHD MIS in the first and second subscale.…”

Section: Discussionmentioning

confidence: 99%

The readiness for hospital discharge of patients after acute myocardial infarction: a new self-reported questionnaire

Buszko

Kosobucka²,

Michalski³

et al. 2017

Self Cite

The readiness for hospital discharge of patients after acute myocardial infarction: a new self-reported questionnaire ABSTRACT Introduction. Medical care providers are responsible for adequate preparation of patients for discharge from the hospital. The purpose of this study was to validate a new self-reported questionnaire assessing the readiness of patients for hospital discharge. The scoring less than 44 points for the entire questionnaire indicates low readiness, obtaining between 44 and 57 points indicates medium readiness, and scores over 57 points are classified as high readiness for discharge from hospital.Conclusions. The validation procedure revealed that RHD MIS is a reliable and homogeneous tool to measure the readiness of patients for hospital discharge. The set of items divided into three subscales allows subjective and objective evaluation of the patient's knowledge and expectations. Further investigation is needed to assess the potential impact of RHD MIS scoring on long-term outcome.

“…Moreover, the knowledge of reasons of this phenomenon as well as identification of barriers and problems in cooperation between patients and health care professionals is crucial for implementation of tailored educational interventions [79][80][81][82].…”

Section: Expert Opinionmentioning

confidence: 99%

Self-reported questionnaires for assessment adherence to treatment in patients with cardiovascular diseases

Kubica

Kosobucka

Michalski

et al. 2018

Self Cite