Key result
Following a positive P2Y12 test for poor clopidogrel response, 38.8% of patients had no change in therapy, and adding an additional agent was associated with the highest rehospitalization risk.
Why the study?
How is VerifyNow P2Y12 testing utilized and what are the outcomes of subsequent medication changes in patients with poor clopidogrel response?
Observational (n=95)
No
How is VerifyNow P2Y12 testing utilized and what are the outcomes of subsequent medication changes in patients with poor clopidogrel response?
In a community hospital setting, poor clopidogrel response testing often resulted in no therapy change, while adding another antiplatelet or anticoagulant was associated with higher 90-day rehospitalization rates.
Common inaction after positive P2Y12 testing and higher risk with added agents; supports need for randomized evaluation of platelet testing strategies.
Purpose: To describe how VerifyNow P2Y12 testing for clopidogrel response is being utilized at a community hospital. Methods: A retrospective chart review was conducted at a 411-bed community hospital in patients who tested positive for poor clopidogrel response. Results: There were 95 positive P2Y12 tests evaluated in this study. Positive P2Y12 tests were obtained 40.0% of the time for cardiovascular indications, 28.4% for neurologic indications, 1.1% for hematologic indications, and 30.5% were obtained to evaluate patients prior to surgery. The medication regimens of 38.8% of patients did not change as a result of a positive test for poor clopidogrel response. The clopidogrel dose was increased in 16.3% of patients, and clopidogrel was discontinued in 10.2% of patients positive for poor clopidogrel response not undergoing surgical evaluation. Rehospitalization rates of non-surgical patients for recurrent thrombosis or bleeding at 90 days were highest for patients who had an additional antiplatelet agent or anticoagulant added due to poor clopidogrel response. The lowest rehospitalization rate was seen in patients switched to an alternative agent. Conclusions: The most common findings after a positive P2Y12 test in non-surgical patients were no change in therapy and increasing the dose of clopidogrel. Adding an additional antiplatelet agent or anticoagulant was associated with the highest risk of rehospitalization.
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Jeffrey Lalama (2011) conducted an observational in Poor clopidogrel response (n=95). Positive VerifyNow P2Y12 test for poor clopidogrel response was evaluated on Medication regimen changes and rehospitalization rates for recurrent thrombosis or bleeding at 90 days. Following a positive P2Y12 test for poor clopidogrel response, 38.8% of patients had no change in therapy, and adding an additional agent was associated with the highest rehospitalization risk.
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