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Individualised assessment of response to clopidogrel in patients presenting with acute coronary syndromes: a role for short thrombelastography?
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|Title: ||Individualised assessment of response to clopidogrel in patients presenting with acute coronary syndromes: a role for short thrombelastography?|
|Citation: ||Cardiovascular therapeutics, 28 (3):139-146|
|Journal: ||Cardiovascular therapeutics|
|Issue Date: ||2010 |
|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.|
|MeSH: ||Acute Coronary Syndrome|
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Cell Adhesion Molecules
Coronary Artery Bypass
Platelet Aggregation Inhibitors
Predictive Value of Tests
|Appears in Collections: ||Diabetes, Physiology and Molecular Medicine Research Group|
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