Personalised antiplatelet therapy in stent thrombosis: observations from the Clopidogrel Resistance in Stent Thrombosis (CREST) registry
- Nalyaka Sambu1,2,
- Ashwin Radhakrishnan2,
- Hazel Dent2,
- Alison Louise Calver1,
- Simon Corbett1,
- Huon Gray1,
- Iain A Simpson1,
- Nick Curzen1,2
- 1Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- 2University of Southampton, Faculty of Medicine, Southampton, UK
- Correspondence to Professor N Curzen, Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK;
- Accepted 12 January 2012
Objective Previous studies have demonstrated significant heterogeneity in responses to antiplatelet therapy (APT), and high residual platelet reactivity is associated with the risk of ischaemic events, including stent thrombosis (ST). The prevalence of APT hyporesponsiveness in a ‘real world’ registry of ST patients and the feasibility of personalising APT are reported.
Patients and setting 39 consecutive patients admitted to a single regional cardiothoracic centre with definite ST were prospectively evaluated.
Interventions Response to aspirin and clopidogrel was measured following discharge using short thrombelastography (TEG), a rapid, well validated near patient platelet function test. Treatment modification in hyporesponders comprised an increase in aspirin dose and/or changing clopidogrel to prasugrel or ticagrelor. Short TEG was repeated following treatment modification to ensure an adequate response had been achieved.
Results 12 (31%) patients had an adequate response to both aspirin and clopidogrel, 16 (41%) were hyporesponsive to clopidogrel alone, one (3%) was hyporesponsive to aspirin alone and 10 (26%) were hyporesponsive to both aspirin and clopidogrel. Following treatment modification, an adequate response to aspirin and P2Y12 agent was achieved in 10 (91%) and 22 (85%) patients, respectively. None has presented with a further ST episode.
Conclusions There is a high prevalence of hyporesponsiveness to APT in patients with ST. Improved APT efficacy can be achieved by tailored therapy. Short TEG is a plausible platelet function test that can be used to deliver point of care personalised APT.
See Editorial, p 679
Funding This work was supported by an unrestricted grant from Haemonetics and Medtronic UK.
Competing interests NC has received unrestricted research funding from Haemonetics, Medtronic, Boston Scientific and Pfizer. He has also received speaker/consulting fees from Boston Scientific, Abbott, Medtronic, AstraZeneca, Eli Lilly and Cordis.
Provenance and peer review Not commissioned; externally peer reviewed.