Key result
Although high residual platelet reactivity is a predictor of stent thrombosis, tailoring antiplatelet therapy based on platelet function tests has failed to show clinical benefit.
Why the study?
Does tailored antiplatelet therapy based on platelet reactivity testing reduce stent thrombosis and ischemic events in patients undergoing PCI?
Does tailored antiplatelet therapy based on platelet reactivity testing reduce stent thrombosis and ischemic events in patients undergoing PCI?
Although high on-treatment platelet reactivity is a risk factor for stent thrombosis, routine tailored antiplatelet therapy based on platelet function testing has not yet demonstrated clinical benefit in early trials.
TrombĂłza stentu (stent thrombosis - ST) je sice vzĂĄcnou, ale potenciĂĄlnÄ Ĺživot ohroĹžujĂcĂ pĹĂhodou, s nĂĹž se lze setkat po perkutĂĄnnĂ koronĂĄrnĂ intervenci (percutaneous coronary intervention - PCI) s implantacĂ stentu. Ke vzniku trombu a rozvoji ST mĹŻĹže pĹispĂvat nÄkolik faktorĹŻ souvisejĂcĂch se samotnĂ˝m vĂ˝konem nebo charakteristikami pacienta. ZĂĄkladem strategie ke snĂĹženĂ vĂ˝skytu ST je duĂĄlnĂ protidestiÄkovĂĄ lĂŠÄba (dual antiplatelet therapy - DAPT) s kyselinou acetylsalicylovou a inhibitory P2Y12. Byly zjiĹĄtÄny dvÄ hlavnĂ pĹĂÄiny neĂşspÄĹĄnĂŠ DAPT: nevhodnÄ pĹedÄasnÄ ukonÄenĂĄ protidestiÄkovĂĄ lĂŠÄba a snĂĹženĂĄ odpovÄÄ na antiagregancia. PĹibĂ˝vĂĄ dĹŻkazĹŻ o tom, Ĺže reziduĂĄlnĂ vysokĂĄ reaktivita bÄhem lĂŠÄby (high platelet reactivity - HPR) je spojena se zvýťenĂ˝m rizikem trombotickĂ˝ch komplikacĂ vÄetnÄ ST po PCI. V poslednĂch letech byla vyvinuta Ĺada testĹŻ na stanovenĂ funkce krevnĂch destiÄek; nÄkterĂŠ z tÄchto testĹŻ se ve velkĂŠ mĂĹe pouĹžĂvajĂ v klinickĂ˝ch studiĂch pĹi stanovenĂ reziduĂĄlnĂ reaktivity destiÄek po podĂĄnĂ antiagreganciĂ. Pro optimalizaci protidestiÄkovĂŠ lĂŠÄby je naprosto nezbytnĂŠ vyhledĂĄvĂĄnĂ pacientĹŻ s HPR. PrvnĂ studie nicmĂŠnÄ naznaÄily, Ĺže dosaĹženĂ intenzivnÄjĹĄĂ inhibice krevnĂch destiÄek po pĹevedenĂ pacienta ze standardnĂho na intenzivnĂ lĂŠÄebnĂ˝ reĹžim podle reaktivity destiÄek nezajistilo ŞådnĂ˝ pĹĂnos ve smyslu incidence pĹĂhod. NenĂ pochyb o tom, Ĺže individualizovanĂĄ farmakoterapie u pacientĹŻ absolvujĂcĂch PCI zĹŻstĂĄvĂĄ i nadĂĄle jednĂm z hlavnĂch cĂlĹŻ v ĂşsilĂ o pĹedchĂĄzenĂ vzniku zĂĄvaĹžnĂ˝ch komplikacĂ - vÄetnÄ ST - v souvislosti s PCI.
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Ricottini et al. (2013) conducted a review in Stent thrombosis and high on-treatment platelet reactivity. Tailored antiplatelet therapy based on platelet function testing vs. Standard antiplatelet therapy was evaluated. Although high residual platelet reactivity is a predictor of stent thrombosis, tailoring antiplatelet therapy based on platelet function tests has failed to show clinical benefit.
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