PMID- 26033398
OWN - NLM
STAT- MEDLINE
DCOM- 20160503
LR  - 20181202
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 136
IP  - 2
DP  - 2015 Aug
TI  - Large early variation of residual platelet reactivity in Acute Coronary Syndrome 
      patients treated with clopidogrel: results from Assessing Platelet Activity in 
      Coronary Heart Disease (APACHE).
PG  - 335-40
LID - S0049-3848(15)00248-0 [pii]
LID - 10.1016/j.thromres.2015.05.021 [doi]
AB  - INTRODUCTION: There is a large inter-individual variation in response to 
      clopidogrel treatment and previous studies have indicated higher risk of 
      thrombotic events in patients with high residual platelet reactivity (HRPR), but 
      the optimal time-point for testing is not established. The aim of this study was 
      to investigate the optimal time-point for aggregometry testing and the risk of 
      major adverse cardiac events associated with HRPR. METHOD AND RESULTS: We 
      included 125 patients with ACS (73 with STEMI, and 71 received abciximab). The 
      prevalence of HRPR varied substantially over time. The rate of HRPR in patients 
      treated and not treated with abciximab were 43% vs 67% (p=0.01) before, 2% vs 23% 
      (p=0.001) 6-8h after, 8% vs 9% (p=0.749) 3days after, and 23% vs 12% (p=0.138) 
      7-9 days after loading dose of clopidogrel. We found HRPR in 18% of the patients 
      but only four ischemic events during 6months follow-up, with no significant 
      difference between HRPR patients compared to the rest of the population. There 
      were 3 TIMI major bleedings, all of which occurred in the low residual platelet 
      reactivity (LRPR) group. CONCLUSION: There is a large variation in platelet 
      reactivity over time, also depending on adjunctive therapy, which has a large 
      impact on optimal time-point for assessment. We found HRPR in almost 1 in 5 
      patients, but very few MACE, and not significantly higher in HRPR patients. In a 
      contemporary ACS population, with low risk for stent thrombosis, the predictive 
      value of HRPR for ischemic events will probably be low.
CI  - Copyright (c) 2015 Elsevier Ltd. All rights reserved.
FAU - Alfredsson, Joakim
AU  - Alfredsson J
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden. Electronic address: joakim.alfredsson@liu.se.
FAU - Lindahl, Tomas L
AU  - Lindahl TL
AD  - Department of Clinical and Experimental Medicine, Linkoping University, 
      Linkoping, Sweden.
FAU - Gustafsson, Kerstin M
AU  - Gustafsson KM
AD  - Department of Clinical and Experimental Medicine, Linkoping University, 
      Linkoping, Sweden.
FAU - Janzon, Magnus
AU  - Janzon M
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
FAU - Jonasson, Lena
AU  - Jonasson L
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
FAU - Logander, Elisabeth
AU  - Logander E
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
FAU - Nilsson, Lennart
AU  - Nilsson L
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
FAU - Swahn, Eva
AU  - Swahn E
AD  - Department of Cardiology and Department of Medical and Health Sciences, Linkoping 
      University, Linkoping, Sweden.
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150522
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Acute Coronary Syndrome/*diagnosis/*drug therapy/physiopathology
MH  - Aged
MH  - Clopidogrel
MH  - Female
MH  - Humans
MH  - Male
MH  - Platelet Aggregation/*drug effects
MH  - Platelet Count/*methods
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Ticlopidine/*analogs & derivatives/therapeutic use
MH  - Treatment Outcome
EDAT- 2015/06/03 06:00
MHDA- 2016/05/04 06:00
CRDT- 2015/06/03 06:00
PHST- 2015/02/07 00:00 [received]
PHST- 2015/04/27 00:00 [revised]
PHST- 2015/05/20 00:00 [accepted]
PHST- 2015/06/03 06:00 [entrez]
PHST- 2015/06/03 06:00 [pubmed]
PHST- 2016/05/04 06:00 [medline]
AID - S0049-3848(15)00248-0 [pii]
AID - 10.1016/j.thromres.2015.05.021 [doi]
PST - ppublish
SO  - Thromb Res. 2015 Aug;136(2):335-40. doi: 10.1016/j.thromres.2015.05.021. Epub 
      2015 May 22.