Key result
There was no statistically significant difference in clopidogrel responsiveness, measured by median VASP platelet reactivity index, between Arab and Jewish patients with ischemic cerebrovascular events (68.7% vs 61.1%, p=0.251).
Why the study?
High on-treatment platelet reactivity to ADP is associated with adverse clinical events, but consensus on its optimal measurement and clinical utility is lacking.
Does clopidogrel responsiveness, measured by VASP platelet reactivity index, differ between Jewish and Arab patients with ischemic cerebrovascular events?
Observational (n=102)
No
Does clopidogrel responsiveness, measured by VASP platelet reactivity index, differ between Jewish and Arab patients with ischemic cerebrovascular events?
Absolute Event Rate: 68.7% vs 61.1%
p-value: p=0.251
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The current practice of a one-size-fits-all strategy [for antiplatelet therapy] doesn't allow us to identify patients who are at higher risk of bleeding because they are too sensitive, or those at the other end of the extreme who are too resistant. We have the tools to move away from this strategy into a more personalized approach, and we have the ability to mitigate risk, which is something we must incorporate into the design of future clinical trials.”
“High platelet reactivity may be the most potent risk factor for ischemic event occurrence in the stented patient, more powerful than any demographic variable.”
In a prospective cohort of patients with ischemic cerebrovascular events, high residual platelet reactivity on clopidogrel was highly prevalent, but no significant pharmacodynamic difference was detected between Jewish and Arab patients.
The addition of clopidogrel to aspirin treatment reduces ischemic events in a wide range of patients with cardiovascular disease. However, recurrent ischemic event occurrence during dual antiplatelet therapy, including stent thrombosis, remains a major concern. Platelet function measurements during clopidogrel treatment demonstrated a variable and overall modest level of P2Y(12) inhibition. High on-treatment platelet reactivity to adenosine diphosphate (ADP) was observed in selected patients. Multiple studies have now demonstrated a clear association between high on-treatment platelet reactivity to ADP measured by multiple methods and adverse clinical event occurrence. However, the routine measurement of platelet reactivity has not been widely implemented and recommended in the guidelines. Reasons for the latter include: 1) a lack of consensus on the optimal method to quantify high on-treatment platelet reactivity and the cutoff value associated with clinical risk; and 2) limited data to support that alteration of therapy based on platelet function measurements actually improves outcomes. This review provides a consensus opinion on the definition of high on-treatment platelet reactivity to ADP based on various methods reported in the literature and proposes how this measurement may be used in the future care of patients.
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Bonello et al. (2010) conducted an observational in Ischemic cerebrovascular events (acute ischemic stroke or transient ischemic attack) (n=102). Arab ethnicity vs. Jewish ethnicity was evaluated on VASP platelet reactivity index (PRI) percentage (p=0.251). There was no statistically significant difference in clopidogrel responsiveness, measured by median VASP platelet reactivity index, between Arab and Jewish patients with ischemic cerebrovascular events (68.7% vs 61.1%, p=0.251).
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