Intensified P2Y12 inhibition for high-on treatment platelet reactivity
| Autor: | Fakilahyel S. Mshelbwala, Daniel W. Hugenberg, Rolf P. Kreutz |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Prasugrel business.industry medicine.medical_treatment Percutaneous coronary intervention macromolecular substances Hematology 030204 cardiovascular system & hematology medicine.disease Clopidogrel 03 medical and health sciences 0302 clinical medicine P2Y12 Internal medicine Conventional PCI Cardiology Clinical endpoint Medicine cardiovascular diseases 030212 general & internal medicine Myocardial infarction Cardiology and Cardiovascular Medicine business Ticagrelor medicine.drug |
| Zdroj: | Journal of Thrombosis and Thrombolysis. 50:619-627 |
| ISSN: | 1573-742X 0929-5305 |
| DOI: | 10.1007/s11239-020-02075-x |
| Popis: | High on treatment platelet reactivity (HPR) during treatment with clopidogrel has been consistently found to be strong risk factor for recurrent ischemic events after percutaneous coronary intervention (PCI). Insufficient P2Y12 receptor inhibition contributes to HPR measured by the VerifyNow (VN) assay. Prasugrel and ticagrelor are more potent P2Y12 inhibitors than clopidogrel and commonly substituted for clopidogrel when HPR is documented, however benefit of VN guided intensified antiplatelet therapy is uncertain. We identified patients who had undergone platelet reactivity testing after PCI with VN after pretreatment with clopidogrel (n = 252) in a single center observational analysis. Patients who had HPR defined as PRU > 208 were switched to alternate P2Y12 inhibitors. Primary clinical endpoint was 1-year post PCI combined cardiovascular death, myocardial infarction (MI), and stent thrombosis. One hundred and eight (43%) subjects had HPR and were switched to prasugrel (n = 60) and ticagrelor (n = 48). Risk of recurrent 1-year primary endpoint remained higher for HPR patients switched to either ticagrelor or prasugrel as compared to subjects who had low on treatment platelet reactivity (n = 144) (LPR) on clopidogrel [Hazard Ratio: 3.5 (95% CI 1.1–11.1); p = 0.036)]. Propensity score matched analysis demonstrated higher event rates in patients with HPR on alternate P2Y12 inhibitor as compared to patients with LPR (log-rank: p = 0.044). The increased risk of recurrent events associated with HPR measured by VN is not completely attenuated by switching to more potent P2Y12 inhibitors. Non-P2Y12 mediated pathways likely contribute to increased incidence of thrombotic events after PCI in subjects with HPR. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink