The STIB score: a simple clinical test to predict clopidogrel resistance.
BACKGROUND: High platelet reactivity (HPR) to clopidogrel is associated with an increased risk of ischaemic complications during and after coronary interventions and concerns up to 50% of patients undergoing PCI. AIM OF THE STUDY: The aim of the study was to identify patients with HPR to clopidogrel using bedside clinical information obtained in the Stent Thrombosis In Belgium (STIB) trial. METHODS: Data on platelet reactivity using the VerifyNow® point-of-care assay were obtained in 844 patients undergoing PCI for stable coronary artery disease 12 to 24 hours after a 600-mg loading dose of c... Mehr ...
Verfasser: | |
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Dokumenttyp: | Artikel |
Erscheinungsdatum: | 2015 |
Verlag/Hrsg.: |
Peeters
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Schlagwörter: | Aged / Decision Support Techniques / Diabetes Complications / Drug Resistance / Female / Hemoglobins / Humans / Logistic Models / Male / Middle Aged / Multivariate Analysis / Angina / Stable / Obesity / Odds Ratio / Platelet Aggregation / Platelet Aggregation Inhibitors / Platelet Function Tests / Point-of-Care Testing / Predictive Value of Tests / Prospective Studies / Purinergic P2Y Receptor Antagonists / Receptors / Purinergic P2Y12 / Angioplasty / Balloon / Coronary / Risk Factors / Ticlopidine / Time Factors / Treatment Outcome / Belgium / Biomarkers / Blood Platelets / Body Mass Index / Chi-Square Distribution / Comorbidity / Bleeding / Clopidogrel resistance / Coronary disease / Ischaemic events / Verifynow® |
Sprache: | Englisch |
Permalink: | https://search.fid-benelux.de/Record/base-28537692 |
Datenquelle: | BASE; Originalkatalog |
Powered By: | BASE |
Link(s) : | http://hdl.handle.net/2078.1/176260 |
BACKGROUND: High platelet reactivity (HPR) to clopidogrel is associated with an increased risk of ischaemic complications during and after coronary interventions and concerns up to 50% of patients undergoing PCI. AIM OF THE STUDY: The aim of the study was to identify patients with HPR to clopidogrel using bedside clinical information obtained in the Stent Thrombosis In Belgium (STIB) trial. METHODS: Data on platelet reactivity using the VerifyNow® point-of-care assay were obtained in 844 patients undergoing PCI for stable coronary artery disease 12 to 24 hours after a 600-mg loading dose of clopidogrel was given. Demographic, clinical and baseline routine biological tests were obtained and compared with P2Y12 reaction units (PRU). Patients with PRU>230 (HPR) were considered as non-responders to clopidogrel. RESULTS: HPR was observed in 424/844 pts. Age, weight, body mass index (BMI), HPR to aspirin, diabetes, renal failure (MDRD<60 ml/min), haemoglobin (Hb), haematocrit, fibrinogen, glycaemia and glycated haemoglobin were associated with HPR to clopidogrel. In multivariate analysis, only Hb (OR: 0.77), BMI (OR: 1.06) and diabetes (OR: 1.62) emerged as independent risk factors. Hb<13.9 g/dl, BMI>28 kg/m2 and presence of diabetes were equally associated to predict HPR and can be added to derive a simple score to predict clopidogrel resistance. Although 38.5% of patients without a single clinical predictor still have HPR, 2/3 patients with 2 or 3 risk factors are resistant to clopidogrel. CONCLUSIONS: STIB HPR score allows identification of patients with a high probability of resistance to clopidogrel based on diabetes, Hb<13.9 g/dl and BMI>28 kg/m2. This bedside clinical test could be useful for the identification of patients in whom another P2Y12 inhibitor should be recommended before and after PCI.