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Personalized Antiplatelet Treatment Improves PCI Outcome According To Study

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Personalized Antiplatelet Treatment Improves PCI Outcome According To Study

According to a research presented at the ESC Congress 2012, individualized antiplatelet treatment has better results than the standard treatment. Clopidogrel is an antiplatelet agent which, along with aspirin, is part of standard therapy for patients who underwent PCI (percutaneous coronary intervention) in order to prevent thrombosis. The aim of the study was to adjust antiplatelet treatment considering patient characteristics, because measurements of platelet aggregation in clopidogrel treated patients indicate that one patient in four is a non-responder to the drug. Multiple studies have demonstrated that non-responsiveness to clopidogrel is attributed to its hepatic metabolism and is aggravated by certain factors such as diabetes, body mass index, acute coronary syndrome, ejection fraction and renal failure. It was demonstrated that the association between non-responsiveness to clopidogrel and short-term adverse effects, particularly with stent thrombosis.

Dr Siller-Matula, first author of the study, pointed out that since antihypertensive treatment is adjusted according to blood pressure and antidislipidemic treatment is corrected according to the level of blood cholesterol, then the antiplatelet therapy should be adjusted according to platelet inhibition. In the MADONNA (Multiple electrode Aggregometry Dual antiplatelet therapy in Patients Receiving Treatment with Novel platelet guide tO Antagonists) study were investigated 798 patients. Researchers analyzed the patient’s level of platelet inhibition using  a technique called multiple electrode aggregometry (MEA). This technique shows whether or not patients are resistant to standard antiplatelet therapy. Dr Siller-Matula, first author of the study, said that this is a very quick blood test that classify patients into responders and non-responders. In addition, she added, that individualized antiplatelet therapy may reduce the costs of drug therapy because it avoids the use of new generation of antiplatelet agents such as prasugrel or ticagrelor.

Percutaneous Coronary Intervention

Percutaneous Coronary Intervention

Patients included into MADONNA study were divided into two groups: the guided group and the non-guided group. In the guided group (n=403), clopidogrel non-responders patients (26%) received up to four loading doses of clopidogrel or prasugrel, the most potent platelet inhibitor available. In the non-guided group (n=395), clopidogrel non-responders (25%) received standard antiplatelet treatment based on clopidogrel and aspirin.

Study results showed that patients from non-guided group presented an 8 time higher risk to develop stent thrombosis compared with patients from guided group (1.9% versus 0.2%). In addition, in the guided group, there were no patients with acute coronary syndrome, while in the non-guided group, this complication occurred in 2.5% of patients. There were no differences between the two groups in the rates of cardiac death or major bleeding.

Antiplatelet therapy is used in patients who underwent PCI (percutaneous coronary intervention). PCI involves implanting a stent in a coronary artery that supplies blood to the heart. PCI is a procedure that is applied especially to patients with STEMI, ST-elevation myocardial infarction. One of the most common complications of PCI is stent thrombosis. Therefore, after this intervention, the patient must follow antiplatelet therapy to prevent stent thrombosis, which consists of aspirin and clopidogrel. But some patients do not respond to standard treatment and for this reason antiplatelet therapy should be personalized according to platelet inhibition.

Introducing clopidogrel testing into clinical practice might be feasible: it involves a blood sample and takes ten minutes to get a result. 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., said Dr Siller-Matula, first author of the study.