Individualised assessment of response to clopidogrel in patients presenting with acute coronary syndromes: a role for short thrombelastography?

2.50
Hdl Handle:
http://hdl.handle.net/2436/113807
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.
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.
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
Type:
Article
Language:
en
ISSN:
1755-5922
Appears in Collections:
Diabetes, Physiology and Molecular Medicine Research Group

Full metadata record

DC FieldValue Language
dc.contributor.authorCotton, James M.en
dc.contributor.authorWorrall, A. M.en
dc.contributor.authorHobson, A. R.en
dc.contributor.authorSmallwood, A.en
dc.contributor.authorAmoah, V.en
dc.contributor.authorDunmore, Simon J.en
dc.contributor.authorNevill, Alan M.en
dc.contributor.authorRaghuraman, R. P.en
dc.contributor.authorVickers, J.en
dc.contributor.authorCurzen, N.en
dc.date.accessioned2010-10-26T14:15:46Z-
dc.date.available2010-10-26T14:15:46Z-
dc.date.issued2010-
dc.identifier.citationCardiovascular therapeutics, 28 (3):139-146en
dc.identifier.issn1755-5922-
dc.identifier.pmid20406238-
dc.identifier.doi10.1111/j.1755-5922.2010.00156.x-
dc.identifier.urihttp://hdl.handle.net/2436/113807-
dc.description.abstractINTRODUCTION: 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.en
dc.language.isoenen
dc.subjectPlateleten
dc.subjectClopidogrelen
dc.subjectAnginaen
dc.subjectThrombelastographyen
dc.subjectFlow-Cytometryen
dc.subjectVASPen
dc.subject.meshAcute Coronary Syndromeen
dc.subject.meshAdulten
dc.subject.meshAgeden
dc.subject.meshAged, 80 and overen
dc.subject.meshAngioplasty, Transluminal, Percutaneous Coronaryen
dc.subject.meshBiological Markersen
dc.subject.meshCell Adhesion Moleculesen
dc.subject.meshCoronary Artery Bypassen
dc.subject.meshDrug Monitoringen
dc.subject.meshEnglanden
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshMicrofilament Proteinsen
dc.subject.meshMiddle Ageden
dc.subject.meshPhosphoproteinsen
dc.subject.meshPhosphorylationen
dc.subject.meshPlatelet Aggregationen
dc.subject.meshPlatelet Aggregation Inhibitorsen
dc.subject.meshPredictive Value of Testsen
dc.subject.meshProspective Studiesen
dc.subject.meshStentsen
dc.subject.meshThrombelastographyen
dc.subject.meshTiclopidineen
dc.subject.meshTime Factorsen
dc.subject.meshTreatment Outcomeen
dc.titleIndividualised assessment of response to clopidogrel in patients presenting with acute coronary syndromes: a role for short thrombelastography?en
dc.typeArticleen
dc.identifier.journalCardiovascular therapeuticsen

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