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dc.contributor.authorCotton, James M.
dc.contributor.authorWorrall, A. M.
dc.contributor.authorHobson, A. R.
dc.contributor.authorSmallwood, A.
dc.contributor.authorAmoah, V.
dc.contributor.authorDunmore, Simon J.
dc.contributor.authorNevill, Alan M.
dc.contributor.authorRaghuraman, R. P.
dc.contributor.authorVickers, J.
dc.contributor.authorCurzen, N.
dc.date.accessioned2010-10-26T14:15:46Z
dc.date.available2010-10-26T14:15:46Z
dc.date.issued2010
dc.identifier.citationCardiovascular therapeutics, 28 (3):139-146
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.
dc.language.isoen
dc.subjectPlatelet
dc.subjectClopidogrel
dc.subjectAngina
dc.subjectThrombelastography
dc.subjectFlow-Cytometry
dc.subjectVASP
dc.subject.meshAcute Coronary Syndrome
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshAngioplasty, Transluminal, Percutaneous Coronary
dc.subject.meshBiological Markers
dc.subject.meshCell Adhesion Molecules
dc.subject.meshCoronary Artery Bypass
dc.subject.meshDrug Monitoring
dc.subject.meshEngland
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshMale
dc.subject.meshMicrofilament Proteins
dc.subject.meshMiddle Aged
dc.subject.meshPhosphoproteins
dc.subject.meshPhosphorylation
dc.subject.meshPlatelet Aggregation
dc.subject.meshPlatelet Aggregation Inhibitors
dc.subject.meshPredictive Value of Tests
dc.subject.meshProspective Studies
dc.subject.meshStents
dc.subject.meshThrombelastography
dc.subject.meshTiclopidine
dc.subject.meshTime Factors
dc.subject.meshTreatment Outcome
dc.titleIndividualised assessment of response to clopidogrel in patients presenting with acute coronary syndromes: a role for short thrombelastography?
dc.typeArticle
dc.identifier.journalCardiovascular therapeutics
html.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.


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