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Wolverhampton Intellectual Repository and E-Theses > Research Institutes > Research Institute in Healthcare Science > Diabetes, Physiology and Molecular Medicine Research Group > Individualised assessment of response to clopidogrel in patients presenting with acute coronary syndromes: a role for short thrombelastography?

Please use this identifier to cite or link to this item: http://hdl.handle.net/2436/113807
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Title: Individualised assessment of response to clopidogrel in patients presenting with acute coronary syndromes: a role for short thrombelastography?
Authors: Cotton, James M.
Worrall, A. M.
Hobson, A. R.
Smallwood, A.
Amoah, V.
Dunmore, Simon J.
Nevill, Alan M.
Raghuraman, R. P.
Vickers, J.
Curzen, N.
Citation: Cardiovascular therapeutics, 28 (3):139-146
Journal: Cardiovascular therapeutics
Issue Date: 2010
URI: http://hdl.handle.net/2436/113807
DOI: 10.1111/j.1755-5922.2010.00156.x
PubMed ID: 20406238
Abstract: 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.
Type: Article
Language: en
Keywords: Platelet
Clopidogrel
Angina
Thrombelastography
Flow-Cytometry
VASP
MeSH: Acute Coronary Syndrome
Adult
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Biological Markers
Cell Adhesion Molecules
Coronary Artery Bypass
Drug Monitoring
England
Female
Humans
Male
Microfilament Proteins
Middle Aged
Phosphoproteins
Phosphorylation
Platelet Aggregation
Platelet Aggregation Inhibitors
Predictive Value of Tests
Prospective Studies
Stents
Thrombelastography
Ticlopidine
Time Factors
Treatment Outcome
ISSN: 1755-5922
Appears in Collections: Diabetes, Physiology and Molecular Medicine Research Group

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