| Individualised assessment of response to clopidogrel in patients presenting with acute coronary syndromes: a role for short thrombelastography? | |
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MedLine Citation:
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PMID: 20406238 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: There is considerable interindividual variation in response to the antiplatelet agent clopidogrel. Hyporesponse predicts negative outcomes in patients presenting with a variety of ischemic cardiac conditions and following intracoronary stent placement. Many tests of clopidogrel activity are time consuming and complex. Short thromboelastography (s-TEG) allows rapid measurement of platelet clopidogrel response. AIMS: We initiated this study to investigate the utility of s-TEG in assessing the response to clopidogrel in patients presenting with acute coronary syndromes (ACS) and to compare these results with established clopidogrel monitoring techniques. METHODS: Patients admitted with unstable angina (UA) or Non ST elevation myocardial infarction (NSTEMI) undergoing coronary angiography were recruited. After routine loading with clopidogrel, all patients were tested with s-TEG and Accumetrics Verify-Now rapid platelet function analyzer (VN-RPFA). We used the modified TEG technique of measuring area under the curve at 15 min (AUC15), which allows a rapid estimation of antiplatelet response. Vasodilator-stimulated phosphoprotein phosphorylation (VASP) was also tested in a subgroup of patients. Clinical follow-up was obtained at 1 year. s-TEG results were correlated with VN-RPFA and VASP findings. RESULTS: A total of 49 patients (33 male, mean age 63) were recruited and tested with s-TEG and VN-RPFA and a total of 39 patients were also assessed with VASP. s-TEG readings correlated well with VN-RPFA (r(2)= 0.54, P < 0.0001) and VASP (r(2)= 0.26, P= 0.001). CONCLUSION: s-TEG provides timely results which compare to current tests of clopidogrel activity. This technique can also be used to measure a variety of other clotting parameters and as such could develop into a valuable near patient test for the interventional cardiologist. |
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Authors:
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J M Cotton; A M Worrall; A R Hobson; A Smallwood; V Amoah; S Dunmore; A M Nevill; R P Raghuraman; R Rajendra; J Vickers; N Curzen |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2010-04-19 |
Journal Detail:
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Title: Cardiovascular therapeutics Volume: 28 ISSN: 1755-5922 ISO Abbreviation: Cardiovasc Ther Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-18 Completed Date: 2010-09-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101319630 Medline TA: Cardiovasc Ther Country: England |
Other Details:
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Languages: eng Pagination: 139-46 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK. james.cotton@rwh-tr.nhs.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
/
blood,
drug therapy,
surgery,
therapy* Adult Aged Aged, 80 and over Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects, instrumentation Biological Markers / blood Cell Adhesion Molecules / blood Coronary Artery Bypass* / adverse effects Drug Monitoring / methods* England Female Humans Male Microfilament Proteins / blood Middle Aged Phosphoproteins / blood Phosphorylation Platelet Aggregation / drug effects* Platelet Aggregation Inhibitors / therapeutic use* Predictive Value of Tests Prospective Studies Stents Thrombelastography* Ticlopidine / analogs & derivatives*, therapeutic use Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Cell Adhesion Molecules; 0/Microfilament Proteins; 0/Phosphoproteins; 0/Platelet Aggregation Inhibitors; 0/vasodilator-stimulated phosphoprotein; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel |
| Comments/Corrections | |
Erratum In:
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Cardiovasc Ther. 2010 Aug;28(4):254 Note: Rajendra, R [corrected to Raghuraman, R P] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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