Key result
Clopidogrel is linked to higher on-treatment platelet reactivity post-PCI versus ticagrelor and prasugrel.
Why the study?
Patients with high on-treatment platelet reactivity on P2Y12 inhibitors are at higher risk of thrombotic complications, but whether testing for it benefits high-risk patients after complex PCI is unclear.
Does the type of P2Y12 inhibitor affect the rate of high on-treatment platelet reactivity in patients undergoing complex PCI?
Observational
Does the type of P2Y12 inhibitor affect the rate of high on-treatment platelet reactivity in patients undergoing complex PCI?
A significant proportion of patients undergoing complex PCI exhibit high on-treatment platelet reactivity, particularly those on clopidogrel, suggesting a potential role for more potent P2Y12 inhibitors in this high-risk group.
Answers are grounded in this paper and cite their sources.
Clopidogrel-associated HTPR post-complex PCI warrants caution; hypothesis-generating and requires RCTs before practice change.
Patient response to P2Y12 inhibitor therapy is heterogeneous, and those with high on-treatment platelet reactivity (HTPR) are at an increased risk of thrombotic complications. The aim of our study was to determine whether selecting a high-risk patient group of individuals after complex percutaneous coronary intervention (PCI) would show the clinical benefit of HTPR testing for preventing thrombotic complications. Blood samples of patients after complex PCI were acquired 1 day and 1 month after the intervention. The samples were tested using vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) and platelet function assay (PFA). The occurrence of clinically significant stent thrombosis with repeated revascularization of the target vessel was observed over a 1-year period. One day after PCI, 37% of patients had HTPR as established by VASP-P. One month after PCI, the percentage of patients with HTPR decreased to 30.9%. According to PFA, 1 day after PCI, 33.3% of patients had HTPR. This percentage declined to 19.8% after 1 month. All measurements identified a significantly higher proportion of HTPR in patients on clopidogrel compared to ticagrelor and prasugrel. Two cases of early stent thrombosis and 1 case of late stent thrombosis were identified. Further study of adenosine diphosphate receptor blocker on-treatment response in patients undergoing complex PCI is necessary.
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Urban et al. (2023) conducted an observational in Complex percutaneous coronary intervention (PCI). P2Y12 inhibitor therapy was evaluated on Clinically significant stent thrombosis with repeated revascularization of the target vessel. P2Y12 inhibitor therapy with clopidogrel resulted in a significantly higher proportion of high on-treatment platelet reactivity compared to ticagrelor and prasugrel (37% overall at 1 day post-PCI).
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