J. Jaitner (1), J. Stegherr (1), T. Morath (1), S. Braun (1), I. Bernlochner (1), A. Schömig (1), A. Kastrati (1), D. Sibbing (1)
(1) Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany
Interindividual response variability to clopidogrel treatment is a well established phenomenon. In recent studies and ongoing large-scale trials where patients with high on-treatment platelet reactivity (HPR) to clopidogrel are being randomised to an intensified antiplatelet treatment, confirmation of the HPR phenotype is based on one single platelet function assessment. The stability of the HPR phenotype over time has never been investigated but should be considered crucial for justification of intensified antiplatelet treatment regimens beyond clinical trials. The goal of this study was to test for the stability of the HPR phenotype over time in clopidogrel-treated patients. Patients (n=31) under chronic clopidogrel treatment (75 mg/day) were investigated by serial adenosine diphosphate (ADP)-induced platelet aggregation assessment with multiple electrode aggregometry (MEA) on a Multiplate analyser and light transmission aggregometry (LTA) at three different time points (once per week) during monitored antiplatelet treatment. On the basis of a cut-off level approach (468 AU*min for MEA, 53% for LTA) patients were classified into patients with (n=27) or without (n=4) HPR. For MEA, the phenotype was stable in 93.5% (n=29) of patients whereas 6.5% (n=2) crossed the cut-off level. For LTA, the phenotype was stable in 68% (n=21) of patients whereas 32% (n=10) patients crossed the cut-off level (chi-square P=0.01 for comparison of phenotype stability between both assays). In conclusion, the HPR phenotype is stable over time in the majority of clopidogrel-treated patients. Comparative assessment of phenotype stability across available platelet function assays warrants further investigation.
clopidogrel, platelet aggregation, High on-treatment platelet reactivity
Joseph A. Jakubowski1, Christopher D. Payne2, Ying G. Li1, John T. Brandt1, David S. Small1, Nagy A. Farid1, Daniel E. Salazar3, Kenneth J. Winters1
Thromb Haemost 2008 99 2: 409-415
Dirk Sibbing, Siegmund Braun, Stefan Jawansky, Wolfgang Vogt, Julinda Mehilli, Albert Schömig, Adnan Kastrati, Nicolas von Beckerath
Thromb Haemost 2008 99 1: 121-126
Transferring from clopidogrel loading dose to prasugrel loading dose in acute coronary syndrome patients
High on-treatment platelet reactivity analysis of the TRIPLET trial
J. G. Diodati (1), J. F. Saucedo (2), T. E. Cardillo (3), J. A. Jakubowski (3), C. Henneges (4), M. B. Effron (3), F. R. Lipkin (5), J. R. Walker (5), S. Duvvuru (3), S. S. Sundseth (6), H. N. Fisher (7), D. J. Angiolillo (8)
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