Perkütan Koroner İşlem Yapılan Hastalarda Klopidogrel Direncinin Klinik Belirteçleri

Year 2019, , 55 - 61, 25.03.2019

Cem Özde Osman Kayapinar

https://doi.org/10.18521/ktd.444477

Abstract

Keywords

clopidogrel resistance, coronary artery disease, hemoglobin

Clinical Markers of Clopidogrel Resistance in Percutaneous Coronary-Treated Patients

Abstract

Abstart
Objective: Antiplatelet therapy is an indispensable part of current coronary
artery disease and resistance to ADP inhibitors leads to adverse cardiovascular
events in patients. In this study, it was aimed to detect clopidogrel
resistance markers in patients undergoing percutaneous coronary intervention.

METHODS: Eighty consecutive patients (38 clopidogrel
resistance, 42 controls) who underwent percutan intervention procedure due to
coronary artery disease and who had tested positive for clopidogrel resistance at
the end of the first week were included in the study. In the VerifyNow
test,> 208 platelet reactivity unit clopidogrel resistance and> 550
aspirin reaction unit were accepted as aspirin resistance. 28 patients were
treated with ST elevation MI, 18 patients without ST elevation MI, and the
other patients were treated for stable coronary disease. Demographic findings,
CV and family background variables, body mass index, injection fraction,
aspirin resistance and biochemical parameters were compared.

Findings: The mean age of the patients was 59 ± 12 and
15 were female. Subjects with clopidogrel resistance were significantly lower
in Hemoglobin values. Resistance was more frequent in hypertension, while
female sex and smokers were more frequent. Logistic regression analysis showed that
hemoglobin (odds ratio = 0.8; 95% safety interval (0.678-0.945), p = 0.008]
significantly predicted clopidogrel resistance.

Conclusion: Low hemoglobin level predicts clopidogrel
resistance independently of other clinical variables

Keywords

clopidogrel resistance, coronary artery disease, hemoglobin

References

• KAYNAKLAR1. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996;348:1329-39.
• 2. Steinhubl SR, Berger PB, Mann JT 3rd, Fry ET, DeLago A, Wilmer C, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. CREDO Investigators. Clopidogrel for the Reduction of Events During Observation. JAMA 2002;288:2411-20.
• 3. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. N Engl J Med 2001;345:494-502
• 4. Dupont AG, Gabriel DA, Cohen MG. Antiplatelet therapies and the role of antiplatelet resistance in acute coronary syndrome. Thromb Res 2009;124:6-13.
• 5. Gurbel PA, Bliden KP, Hiatt BL, O’Connor CM. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003;107:2908-13.
• 6. Patti G, Nusca A, Mangiacapra F, Gatto L, D’Ambrosio A, Di Sciascio G. Point-of-care measurement of clopidogrel responsiveness predicts clinical outcome in patients undergoingpercutaneous coronary intervention results of the ARMYDA-PRO (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity Predicts Outcome study. J Am Coll Cardiol. 2008; 52: 1128-1133.
• 7. Jeong YH, Kim IS, Choi BR, Kwak CH, Hwang JY. The optimal threshold of high post-treatment platelet reactivity could be defined by a point-of-care VerifyNow P2Y12 assay. Eur Heart J. 2008; 29: 2186-2187.
• 8. Campo G, Fileti L, de Cesare N, Meliga E, Furgieri A, Russo F, Colangelo S, Brugaletta S, Ferrari R, Valgimigli M. Long-term clinical outcome based on aspirin and clopidogrel responsiveness status after elective percutaneous coronary intervention: a 3T/2r (Tailoring Treatment With Tirofiban inPatients Showing Resistance to Aspirin and/or Resistance to Clopidogrel) trial substudy. J Am Coll Cardiol. 2010;56:1447–1455.
• 9. Price MJ, Angiolillo DJ, Teirstein PS, Lillie E, Manoukian SV, Berger PB, Tanguay JF, Cannon CP, Topol EJ.Platelet reactivity and cardiovascular outcomes after percutaneous coronary intervention: a time-dependent analysis of the Gauging Responsiveness with a VerifyNow P2Y12 assay: Impact on Thrombosis and Safety (GRAVITAS) trial. Circulation. 2011 Sep 6;124(10):1132-37
• 10. Cuisset T, Frere C, Quilici J, Morange PE, Camoin L, Bali L, Lambert M, Juhan-Vague I, Alessi MC, Bonnet JL. Relationship between aspirin and clopidogrel responses in acute coronary syndrome and clinical predictors of non response. Thromb Res. 2009 Feb;123(4):597-603
• 11. Kim H, Lee HK, Han K, Jeon HK. Prevalence and Risk Factors for Aspirin and Clopidogrel Resistance in Patients with Coronary Artery Disease or Ischemic Cerebrovascular Disease. Ann Clin Lab Sci. 2009 Summer;39(3):289-94.
• 12. Fontana P, Berdagué P, Castelli C, Nolli S, Barazer I, Fabbro-Peray P, Schved JF, Bounameaux H, Mach F, DE Moerloose P, Reny JL. Clinical predictors of dual aspirin and clopidogrel poor responsiveness in stable cardiovascular patients from the ADRIE study. J Thromb Haemost. 2010 Dec;8(12):2614-2
• 13. Kakouros N, Kickler TS, Laws KM, Rade JJ. Hematocrit alters VerifyNow P2Y12 assay results independently of intrinsic platelet reactivity and clopidogrel responsiveness. J Thromb Haemost. 2013 Oct;11(10):1814-2
• 14. Price MJ, Berger PB, Teirstein PS, et al. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA 2011; 305:1097.
• 15. Campo G, Fileti L, de Cesare N, et al. Long-term clinical outcome based on aspirin and clopidogrel responsiveness status after elective percutaneous coronary intervention: a 3T/2R (tailoring treatment with tirofiban in patients showing resistance to aspirin and/or resistance to clopidogrel) trial substudy. J Am Coll Cardiol 2010; 56:1447.
• 16. Cuisset T, Frere C, Quilici J, et al. Glycoprotein IIb/IIIa inhibitors improve outcome after coronary stenting in clopidogrel nonresponders: a prospective, randomized study. JACC Cardiovasc Interv 2008; 1:649
• 17. Trenk D, Stone GW, Gawaz M, et al. A randomized trial of prasugrel versus clopidogrel in patients with high platelet reactivity on clopidogrel after elective percutaneous coronary intervention with implantation of drug-eluting stents: results of the TRIGGER-PCI (Testing Platelet Reactivity In Patients Undergoing Elective Stent Placement on Clopidogrel to Guide Alternative Therapy With Prasugrel) study. J Am Coll Cardiol 2012; 59:2159.
• 18. Deharo P, Loosveld M, Bonnet G, Pankert M, Quilici J, Lambert M, et al. Impact of new P2Y12 blockers on platelet reactivity and clinical outcomes after acute coronary syndrome: Insight from a large single center registry. IJC Heart & Vessels, 2014; 4, 188–192
• 19. Aradi D, Tornyos A, Pintér T, Vorobcsuk A, Kónyi A, Faluközy J, Veress G, Magyari B, Horváth IG, Komócsi A. Optimizing P2Y12 receptor inhibition in patients with acute coronary syndrome on the basis of platelet function testing: impact of prasugrel and high-dose clopidogrel. J Am Coll Cardiol. 2014 Mar 25;63(11):1061-70