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

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