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Thromb Res. 2016 Feb;138:49-54. doi: 10.1016/j.thromres.2015.12.021. Epub 2015 Dec 24.

Association between high on-treatment platelet reactivity and occurrence of cerebral ischemic events in patients undergoing percutaneous coronary intervention.

Author information

  • 11st Department of Cardiology, Poznan University of Medical Sciences, Poland. Electronic address: komosa.ania@gmail.com.
  • 2Department of Cardiology, Medical University of Vienna, Austria.
  • 31st Department of Cardiology, Poznan University of Medical Sciences, Poland.
  • 4Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poland.
  • 51st Department of Clinical Pharmacology, Poznan University of Medical Sciences, Poland.
  • 6Pathology Department Greater Poland Cancer Centre, Poznan, Poland.

Abstract

INTRODUCTION:

Percutaneous coronary angioplasty (PCI) has become a routine treatment in symptomatic patients with coronary artery disease. The use of new generation drug eluting stents (DES) and dual antiplatelet therapy has significantly improved treatment outcomes and increased patients' safety by reducing the risk of stent thrombosis.

AIMS:

The goal of this study was to assess whether high on treatment platelet reactivity (HTPR), despite clopidogrel treatment, measured with Multiplate Electrode Aggregometer (MEA) is associated with the risk of adverse ischemic cerebral events.

METHODS:

Symptomatic patients with coronary artery disease admitted for coronary angiography and angioplasty (PCI) were consecutively enrolled in this study. 249 consecutive patients underwent coronary artery stenting for stable angina (n=215) or non-ST-elevation acute coronary syndrome (n=34). Inhibition of platelet aggregation was assessed by MEA. Genetic polymorphism of CYP2C19 was tested by HRM Real-Time PCR method in 150 patients.

RESULTS:

Patients with HTPR were more frequently diagnosed with ischemic stroke (p=0.0351, OR=16.818, 95% CI [1.464-193.23]) and other ischemic cerebral events (stroke or TIA, p=0.0339, OR=6.5, 95% CI [1.36-31.07]). Cumulative assessment of all ischemic and hemorrhagic events showed no statistical significance. Cerebral ischemic event was the only adverse event that correlated with CYP2C19 (*2/*2) allele (p=0.0489, OR=10; 95% CI [1.39-71.80]).

CONCLUSIONS:

HTPR assessed by MEA, in patients treated with clopidogrel after coronary artery stenting was found to be an important risk factor of ischemic cerebral events. In concordance, the carriers of CYP2C19*2/*2 allele showed an increased rate of ischemic cerebral events.

Copyright © 2015 Elsevier Ltd. All rights reserved.

KEYWORDS:

Aggregation; Antiplatelet therapy; Clopidogrel; Stroke

PMID:
26826508
[PubMed - in process]
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