Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome

Nadia Paarup Dridi; Pär I Johansson; Jacob T Lønborg; Peter Clemmensen; Maria D Radu; Abbas Qayyum; Frants Pedersen; Rudi Kollslid; Steffen Helqvist; Kari Saunamäki; Henning Kelbæk; Erik Jørgensen; Thomas Engstrøm; Lene Holmvang

doi:10.3109/09537104.2014.948837

Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome

Nadia Paarup Dridi, Pär I Johansson, Jacob T Lønborg, Peter Clemmensen, Maria D Radu, Abbas Qayyum, Frants Pedersen, Rudi Kollslid, Steffen Helqvist, Kari Saunamäki, Henning Kelbæk, Erik Jørgensen, Thomas Engstrøm, Lene Holmvang

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

Aim: To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI). There is a wide variability in the platelet reactivity to clopidogrel and HTPR has been associated with a poor prognosis. Methods: In this observational study, 923 consecutive patients without ST-elevation myocardial infarction (STEMI) and adequately pre-treated with clopidogrel were screened for HTPR with multiple electrode aggregometry after assessment of the coronary anatomy. Patients were grouped based on their response to clopidogrel and the assigned antiplatelet strategy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis. Results: HTPR was demonstrated in 237 patients (25.7%). Of these, 114 continued on conventional clopidogrel therapy, while the remaining 123 received intensified antiplatelet therapy with either double-dose clopidogrel (150 mg daily, n = 55) or the newer P2Y12-inhibitors, prasugrel or ticagrelor (n = 68) for at least 30 days after the index procedure. The median follow-up was 571 days (interquartile range, 373-746). Intensifying antiplatelet therapy reduced the rate of the composite endpoint (p < 0.001). After adjustment for potential confounders, HTPR in combination with conventional clopidogrel therapy remained independently associated with an increased risk of cardiovascular events (hazard ratio (HR), 2.92; 95% CI, 1.90-4.48), whereas intensified treatment reduced the risk to a level equivalent to that of patients exhibiting normal platelet reactivity (HR, 1.08; 95% CI, 0.59-1.99). Conclusion: Tailored antiplatelet therapy significantly reduced the event rate in patients exhibiting HTPR prior to PCI.

Original language	English
Journal	Platelets
Volume	26
Issue number	6
Pages (from-to)	521-529
Number of pages	9
ISSN	0953-7104
DOIs	https://doi.org/10.3109/09537104.2014.948837
Publication status	Published - 18 Aug 2015

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Paarup Dridi, N., Johansson, P. I., Lønborg, J. T., Clemmensen, P., Radu, M. D., Qayyum, A., Pedersen, F., Kollslid, R., Helqvist, S., Saunamäki, K., Kelbæk, H., Jørgensen, E., Engstrøm, T., & Holmvang, L. (2015). Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome. Platelets, 26(6), 521-529. https://doi.org/10.3109/09537104.2014.948837

Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome. / Paarup Dridi, Nadia; Johansson, Pär I; Lønborg, Jacob T et al.

In: Platelets, Vol. 26, No. 6, 18.08.2015, p. 521-529.

Research output: Contribution to journal › Journal article › Research › peer-review

Paarup Dridi, N, Johansson, PI, Lønborg, JT, Clemmensen, P, Radu, MD, Qayyum, A, Pedersen, F, Kollslid, R, Helqvist, S, Saunamäki, K, Kelbæk, H, Jørgensen, E, Engstrøm, T & Holmvang, L 2015, 'Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome', Platelets, vol. 26, no. 6, pp. 521-529. https://doi.org/10.3109/09537104.2014.948837

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title = "Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome",

abstract = "Aim: To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI). There is a wide variability in the platelet reactivity to clopidogrel and HTPR has been associated with a poor prognosis. Methods: In this observational study, 923 consecutive patients without ST-elevation myocardial infarction (STEMI) and adequately pre-treated with clopidogrel were screened for HTPR with multiple electrode aggregometry after assessment of the coronary anatomy. Patients were grouped based on their response to clopidogrel and the assigned antiplatelet strategy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis. Results: HTPR was demonstrated in 237 patients (25.7%). Of these, 114 continued on conventional clopidogrel therapy, while the remaining 123 received intensified antiplatelet therapy with either double-dose clopidogrel (150 mg daily, n = 55) or the newer P2Y12-inhibitors, prasugrel or ticagrelor (n = 68) for at least 30 days after the index procedure. The median follow-up was 571 days (interquartile range, 373-746). Intensifying antiplatelet therapy reduced the rate of the composite endpoint (p < 0.001). After adjustment for potential confounders, HTPR in combination with conventional clopidogrel therapy remained independently associated with an increased risk of cardiovascular events (hazard ratio (HR), 2.92; 95% CI, 1.90-4.48), whereas intensified treatment reduced the risk to a level equivalent to that of patients exhibiting normal platelet reactivity (HR, 1.08; 95% CI, 0.59-1.99). Conclusion: Tailored antiplatelet therapy significantly reduced the event rate in patients exhibiting HTPR prior to PCI.",

author = "{Paarup Dridi}, Nadia and Johansson, {P{\"a}r I} and L{\o}nborg, {Jacob T} and Peter Clemmensen and Radu, {Maria D} and Abbas Qayyum and Frants Pedersen and Rudi Kollslid and Steffen Helqvist and Kari Saunam{\"a}ki and Henning Kelb{\ae}k and Erik J{\o}rgensen and Thomas Engstr{\o}m and Lene Holmvang",

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doi = "10.3109/09537104.2014.948837",

language = "English",

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TY - JOUR

T1 - Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome

AU - Paarup Dridi, Nadia

AU - Johansson, Pär I

AU - Lønborg, Jacob T

AU - Clemmensen, Peter

AU - Radu, Maria D

AU - Qayyum, Abbas

AU - Pedersen, Frants

AU - Kollslid, Rudi

AU - Helqvist, Steffen

AU - Saunamäki, Kari

AU - Kelbæk, Henning

AU - Jørgensen, Erik

AU - Engstrøm, Thomas

AU - Holmvang, Lene

PY - 2015/8/18

Y1 - 2015/8/18

N2 - Aim: To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI). There is a wide variability in the platelet reactivity to clopidogrel and HTPR has been associated with a poor prognosis. Methods: In this observational study, 923 consecutive patients without ST-elevation myocardial infarction (STEMI) and adequately pre-treated with clopidogrel were screened for HTPR with multiple electrode aggregometry after assessment of the coronary anatomy. Patients were grouped based on their response to clopidogrel and the assigned antiplatelet strategy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis. Results: HTPR was demonstrated in 237 patients (25.7%). Of these, 114 continued on conventional clopidogrel therapy, while the remaining 123 received intensified antiplatelet therapy with either double-dose clopidogrel (150 mg daily, n = 55) or the newer P2Y12-inhibitors, prasugrel or ticagrelor (n = 68) for at least 30 days after the index procedure. The median follow-up was 571 days (interquartile range, 373-746). Intensifying antiplatelet therapy reduced the rate of the composite endpoint (p < 0.001). After adjustment for potential confounders, HTPR in combination with conventional clopidogrel therapy remained independently associated with an increased risk of cardiovascular events (hazard ratio (HR), 2.92; 95% CI, 1.90-4.48), whereas intensified treatment reduced the risk to a level equivalent to that of patients exhibiting normal platelet reactivity (HR, 1.08; 95% CI, 0.59-1.99). Conclusion: Tailored antiplatelet therapy significantly reduced the event rate in patients exhibiting HTPR prior to PCI.

AB - Aim: To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI). There is a wide variability in the platelet reactivity to clopidogrel and HTPR has been associated with a poor prognosis. Methods: In this observational study, 923 consecutive patients without ST-elevation myocardial infarction (STEMI) and adequately pre-treated with clopidogrel were screened for HTPR with multiple electrode aggregometry after assessment of the coronary anatomy. Patients were grouped based on their response to clopidogrel and the assigned antiplatelet strategy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis. Results: HTPR was demonstrated in 237 patients (25.7%). Of these, 114 continued on conventional clopidogrel therapy, while the remaining 123 received intensified antiplatelet therapy with either double-dose clopidogrel (150 mg daily, n = 55) or the newer P2Y12-inhibitors, prasugrel or ticagrelor (n = 68) for at least 30 days after the index procedure. The median follow-up was 571 days (interquartile range, 373-746). Intensifying antiplatelet therapy reduced the rate of the composite endpoint (p < 0.001). After adjustment for potential confounders, HTPR in combination with conventional clopidogrel therapy remained independently associated with an increased risk of cardiovascular events (hazard ratio (HR), 2.92; 95% CI, 1.90-4.48), whereas intensified treatment reduced the risk to a level equivalent to that of patients exhibiting normal platelet reactivity (HR, 1.08; 95% CI, 0.59-1.99). Conclusion: Tailored antiplatelet therapy significantly reduced the event rate in patients exhibiting HTPR prior to PCI.

U2 - 10.3109/09537104.2014.948837

DO - 10.3109/09537104.2014.948837

M3 - Journal article

C2 - 25166751

SN - 0953-7104

VL - 26

SP - 521

EP - 529

JO - Platelets

JF - Platelets

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