Document Detail


Clopidogrel response status assessed with Multiplate point-of-care analysis and the incidence and timing of stent thrombosis over six months following coronary stenting.
MedLine Citation:
PMID:  20062919     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Clopidogrel low-responsiveness assessed with multiple electrode platelet aggregometry (MEA) has been shown to be a strong and independent predictor of early stent thrombosis (ST) after coronary stenting. The relation of clopidogrel response status, as assessed with MEA, with incidence and timing of ST during an extended follow-up period has never been reported. Here, we report the six-month follow-up results of a prospective trial assessing clopidogrel responsiveness with MEA in patients undergoing percutaneous coronary intervention (PCI). A total of 1,608 consecutive patients with planned drug-eluting stent placement were enrolled in this study. Before PCI patients uniformly received 600 mg clopidogrel and blood was taken directly before PCI to measure ADP-induced platelet aggregation with MEA. The upper quintile (20%) of patients according to MEA measurements (n=323) was defined as clopidogrel low responders. Compared with normal responders (n=1,285), the cumulative incidence of definite ST within six months was significantly higher in low responders [2.5% vs. 0.4%; OR 6.5; 95% CI, 2.4-17.0; P<0.001]. The combined incidence of definite or probable ST was higher as well in low vs. normal responders [4.1% vs. 0.7%; OR 5.8; 95% CI, 2.8-12.3; P<0.0001]. A significant inverse correlation of MEA values and the timing of definite or probable ST (in days) was observed (Spearman coefficient = -0.45; P=0.04) with events occurring earlier in the low-responder group. MEA measurements are highly predictive for the occurrence of ST during the first six months following coronary stenting. In the majority of clopidogrel low responders suffering ST, the ischaemic event occurs early in the course after the procedure.
Authors:
Dirk Sibbing; Tanja Morath; Siegmund Braun; Julia Stegherr; Julinda Mehilli; Wolfgang Vogt; Albert Sch?mig; Adnan Kastrati; Nicolas von Beckerath
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study     Date:  2009-10-26
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  103     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-11     Completed Date:  2010-03-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  151-9     Citation Subset:  IM    
Affiliation:
Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Lazarettstrasse 36, 80636 M?nchen, Germany. dirk@sibbing.net
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MeSH Terms
Descriptor/Qualifier:
Adenosine Diphosphate / diagnostic use
Aged
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  instrumentation*,  mortality
Blood Coagulation Tests*
Drug Monitoring / methods*
Drug Resistance
Drug-Eluting Stents*
Female
Germany
Humans
Incidence
Kaplan-Meiers Estimate
Male
Middle Aged
Platelet Aggregation / drug effects*
Platelet Aggregation Inhibitors / therapeutic use*
Point-of-Care Systems*
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
ROC Curve
Risk Assessment
Risk Factors
Thrombosis / diagnosis*,  etiology,  mortality,  prevention & control
Ticlopidine / analogs & derivatives*,  therapeutic use
Time Factors
Treatment Failure
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 58-64-0/Adenosine Diphosphate; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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