Navigation Links
Personalized antiplatelet treatment improves outcome after PCI
Date:8/28/2012

The findings were presented by Dr Jolanta Siller-Matula from Medical University of Vienna.

Standard antiplatelet treatment in patients undergoing percutaneous coronary intervention (PCI) consists of a dual antiplatelet therapy with aspirin and an ADP receptor inhibitor such as clopidogrel.

But measurements of platelet aggregation in clopidogrel treated patients indicate that one patient in four is a non-responder to the drug. Such non-responsiveness is attributed to clopidogrel's extensive hepatic metabolism, polymorphisms of metabolising enzymes and drug-drug interactions, with additional contributions coming from clinical variables such as diabetes, body mass index, acute coronary syndrome, ejection fraction and renal failure. Multiple studies have demonstrated a clear association between non-responsiveness to clopidogrel and adverse clinical events. The strongest relationship was found between poor clopidogrel response and short term events, particularly stent thrombosis.

Personalized antiplatelet treatment involves choosing a therapy based on the results of platelet function testing, a measurement which shows how effective an antiplatelet drug such as clopidogrel is at inhibiting platelet aggregation. Non-responders to the drug can be given a higher dose of clopidogrel or an alternate antiplatelet therapy such as the more potent platelet inhibitors prasugrel or ticagrelor. Personalized antiplatelet treatment only in clopidogrel non-responders would be a therapeutic strategy reaching two goals: increase of clinical efficacy only in patients who are at increased risk for ischemic events without exposing patients with a proper clopidogrel response to bleedings with use of very potent platelet antagonists.

In the MADONNA study (Multiple electrode Aggregometry in patients receiving Dual antiplatelet therapy tO guide treatmeNt with Novel platelet Antagonists), Austrian investigators led by Dr Jolanta Siller-Matula from the Medical University of Vienna and Professor Gnter Christ from Kaiser Franz Josef Hospital in Vienna, investigated whether individualized treatment with platelet inhibitors according to the results of whole blood aggregometry improves clinical outcomes in patients undergoing percutaneous coronary intervention.

A total of 798 patients underwent platelet testing with whole blood aggregometry using the multiple electrode aggregometry (MEA) technique, which allowed patients to be classified as clopidogrel responders or non-responders. Patients were then allocated to the guided group or the non-guided group. In the guided group (n=403) clopidogrel non-responders (26%) received up to four loading doses of clopidogrel or after prasugrel became available, the more potent platelet inhibitor prasugrel. In the non-guided group (n=395) clopidogrel non-responders (25%) were further treated with the standard treatment consisting of clopidogrel and aspirin.

Results showed that patients in the non-guided group were at a 7.9-fold higher risk to develop stent thrombosis compared to the patients in the guided group (1.9% versus 0.2%; p=0.027). Furthermore acute coronary syndrome occurred in 0% of patients in the guided group versus 2.5% in the non-guided group (p=0.001). There were no differences between the two groups in the rates of cardiac death or major bleeding.

"Introducing clopidogrel testing into clinical practice might be feasible: it involves a blood sample and takes ten minutes to get a result," said Dr Siller-Matula, first author of the study. "Providing individualized treatment based on the results of MEA instead of using novel antiplatelet drugs in each patient would save costs of drug therapy of about 410 per patient each year. As individualized antiplatelet therapy seems to be cost-effective, it might be of interest to health authorities."

"Physicians would never adjust doses of antihypertensive drugs without knowing blood pressures; statins, without knowing cholesterol levels; or antidiabetic drugs without knowing the HbA1C levels," she added. "So why are we still treating our patients with platelet inhibitors without being aware of levels of platelet inhibition?"


'/>"/>

Contact: European Society of Cardiology
press@escardio.org
33-049-294-8627
European Society of Cardiology
Source:Eurekalert

Related medicine news :

1. New method may allow personalized clinical trial for cancer therapies
2. University of Pennsylvania and Novartis form alliance to expand use of personalized T cell cancer therapy
3. A new genre of diagnostic tests for the era of personalized medicine
4. Personalized Blood Pressure Therapy May Help Diabetics
5. Little Evidence on Value of Treatments for Autism: Report
6. Reducing the side effects of treatment for prostate cancer
7. Little evidence supports autism treatment options in adolescents
8. pH-sensitive liposomal cisplatin improves peritoneal carcinomatosis treatment without side-effects
9. Study: Clot removal devices successful tools for acute ischemic stroke treatment
10. Circadian clock research may enable designer plants, and cancer and diabetes treatments
11. NIH launches trial to evaluate anti-inflammatory treatment for preventing heart attacks, strokes, and cardiovascular deaths
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/26/2016)... Creek, Michigan (PRWEB) , ... June 26, 2016 , ... ... joined as sponsor of the 2016 Cereal Festival and World’s Longest Breakfast Table in ... in honor of the city’s history as home to some of the world’s leading ...
(Date:6/25/2016)... ... June 25, 2016 , ... Experts from ... at AcademyHealth’s Annual Research Meeting June 26-28, 2016, at the Hynes Convention Center ... care topics including advance care planning, healthcare costs and patient and family engagement. ...
(Date:6/25/2016)... ... June 25, 2016 , ... As a lifelong Southern Californian, Dr. ... his M.D from the David Geffen School of Medicine at UCLA. He trained in ... to complete his fellowship in hematology/oncology at the UCLA-Olive View-Cedars Sinai program where he ...
(Date:6/24/2016)... ... June 24, 2016 , ... Those who have experienced traumatic events ... turn to unhealthy avenues, such as drug or alcohol abuse, as a coping mechanism. ... tools for healthy coping following a traumatic event. , Trauma sufferers tend to feel ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... micro-osteoperforation for accelerated orthodontic treatment. Dr. Cheng has extensive experience with all areas ... , AcceleDent, and accelerated osteogenic orthodontics. , Micro-osteoperforation is a revolutionary adjunct ...
Breaking Medicine News(10 mins):
(Date:6/26/2016)... 2016  VMS Rehab Systems, Inc. ( www.vmsrehabsystemsinc.com ) ... measures required to build a strong and stable market ... listed on the OTC Markets-pink current trading platform. ... "We are seeing an anomaly in market trading activities ... by the Company, but shareholders and market players as ...
(Date:6/24/2016)... , June 24, 2016  Global Blood Therapeutics, ... company developing novel therapeutics for the treatment of ... announced the closing of its previously announced underwritten ... at the public offering price of $18.75 per ... were offered by GBT. GBT estimates net proceeds ...
(Date:6/24/2016)... June 24, 2016 The Academy of Managed ... recommendations that would allow biopharmaceutical companies to more ... that make formulary and coverage decisions, a move that ... new medicines. The recommendations address restrictions in ... on the drug label, a prohibition that hinders decision ...
Breaking Medicine Technology: