Key result
ASA or clopidogrel resistance is linked to ~4-fold greater risk of recurrent CV events.
Why the study?
Does dynamic observation of platelet aggregation with subsequent correction of antiplatelet therapy reduce recurrent cardiovascular events in patients with unstable angina after coronary stenting?
Cohort (n=131)
No
Does dynamic observation of platelet aggregation with subsequent correction of antiplatelet therapy reduce recurrent cardiovascular events in patients with unstable angina after coronary stenting?
Laboratory resistance to antiplatelet agents in patients with unstable angina after coronary stenting is associated with a significantly increased risk of recurrent cardiovascular events, highlighting the potential value of platelet aggregation monitoring.
Answers are grounded in this paper and cite their sources.
Laboratory resistance was associated with higher recurrent events post-stenting; leaves open whether platelet monitoring-guided adjustment improves outcomes.
Objective: the aim of the study was evaluation of the clinical significance of high residual platelet reactivity in patients with unstable angina and coronary arteries stenting in the inpatient and outpatient monitoring and development of optimal ways of correction of this condition. Material and Methods: the study included 131 patients with unstable angina after coronary stenting. The main group represented 78 patients (UA) underwent dynamic observation of platelet aggregation (Multiplate aggregometer) on the inpatient and outpatient observations (7 day, 1 month, 6 months, 12 months, 18 months) to identify primary and secondary resistance to antiplatelet agents with subsequent correction of antiplatelet therapy. The control group consisted of 53 patients with standard therapy with antiplatelet agents without control of platelet aggregation. All patients were performed: general blood analysis, biochemical blood analysis with determination of the level of TnI, C-reactive protein, myeloperoxidase, von Willebrand factor, and fibrinogen; the test of thrombin generation, also ECG, EchoCG, 24-hour ECG monitoring, coronary angiography. The Republican Scientific and Practical Center Cardiology, Minsk, Belarus Results: the results of our study showed a reduction in sensitivity to clopidogrel at 24,4% of patients with UA and stenting of the coronary arteries, of which the original clopidogrel in 7,7% of patients, generic clopidogrel 16,7% pts. Reduced sensitivity to acetylsalicylic acid was detected in 17,9% of individuals with UA. Laboratory resistance to ASA and/or clopidogrel increased the relative risk of recurrent cardiovascular events more than 4 times [CI 2,9; 5,6] during the 18 months of observation in comparison with a group of pts with no signs of resistance to antiplatelet agents. Conclusions: execution of aggregatogram to patients with unstable angina and stenting of the coronary arteries allows to identify patients with high residual platelet reactivity, to correct of antiplatelet therapy and to reduce the number of repeat cardiovascular events in patients with signs of laboratory resistance to antiplatelet agents.
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Медведева et al. (2017) conducted a cohort in Unstable angina after coronary stenting (n=131). Laboratory resistance to ASA and/or clopidogrel vs. No signs of resistance to antiplatelet agents was evaluated on Recurrent cardiovascular events (RR 4, 95% CI 2.9-5.6). Laboratory resistance to ASA and/or clopidogrel increased the relative risk of recurrent cardiovascular events more than 4-fold (RR 4; 95% CI 2.9-5.6) over 18 months.
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