Detection of Clopidogrel Hyporesponsiveness Using a Point-of-Care Assay and the Impact of Additional Cilostazol Administration after Coronary Stent Implantation in Diabetic Patients.
10.3904/kjim.2011.26.2.145
- Author:
Tae Hyun YANG
1
;
Doo Il KIM
;
Dong Kie KIM
;
Jae Sik JANG
;
Ung KIM
;
Sang Hoon SEOL
;
Dae Kyeong KIM
;
Geu Ru HONG
;
Jong Seon PARK
;
Dong Gu SHIN
;
Young Jo KIM
;
Yun Kyeong CHO
;
Chang Wook NAM
;
Seung Ho HUR
;
Kwon Bae KIM
;
Dong Soo KIM
Author Information
1. Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
- Publication Type:Original Article ; Multicenter Study
- Keywords:
Cilostazol;
Clopidogrel;
Diabetes mellitus;
Platelet function tests;
Point-of-care systems
- MeSH:
Aged;
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation;
Aspirin/administration & dosage;
Chi-Square Distribution;
Coronary Disease/blood/*therapy;
Diabetes Mellitus, Type 2/*blood;
Drug Therapy, Combination;
Female;
Humans;
Logistic Models;
Male;
Middle Aged;
Platelet Activation/*drug effects;
Platelet Aggregation Inhibitors/*administration & dosage/adverse effects;
*Platelet Function Tests;
*Point-of-Care Systems;
Predictive Value of Tests;
Purinergic P2Y Receptor Antagonists/*administration & dosage/adverse effects;
Registries;
Republic of Korea;
Risk Assessment;
Risk Factors;
*Stents;
Tetrazoles/*administration & dosage/adverse effects;
Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives;
Treatment Outcome
- From:The Korean Journal of Internal Medicine
2011;26(2):145-152
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Impaired responsiveness to clopidogrel is common in patients with type 2 diabetes mellitus (DM). The aim of this study was to evaluate the clinical application of a point-of-care assay to detect impaired responsiveness to clopidogrel after coronary stent implantation in patients with type 2 DM. METHODS: We measured P2Y12 reaction units (PRU) with the VerifyNow point-of-care assay in 544 consecutive patients undergoing dual or triple (i.e., dual plus cilostazol) anti-platelet therapy after coronary stent implantation. High platelet reactivity (HPR) was defined as a PRU value > or = 240. RESULTS: The mean PRU values were 233.5 +/- 83.2 and 190.3 +/- 85.5 in patients undergoing dual or triple anti-platelet therapy, respectively (p < 0.001). Patients with DM manifested higher post treatment PRU values (238.3 +/- 82.4 vs. 210.8 +/- 86.8, p = 0.001) and a higher frequency of HPR (44.8% vs. 31.0%, p = 0.003) as compared to patients without DM. We also found that higher PRU values and a higher frequency of HPR were present in patients with DM who were undergoing both triple and dual anti-platelet therapy. However, the higher post-treatment PRU values observed in patients with DM decreased with triple anti-platelet therapy (219.4 +/- 82.5 vs. 247.9 +/- 81.1, p = 0.044). CONCLUSIONS: A point-of-care assay can detect elevated platelet reactivity and impaired responsiveness to clopidogrel in patients with type 2 DM. The addition of cilostazol to dual anti-platelet therapy may decrease post-treatment PRU values in patients with type 2 DM.
