Personalized antiplatelet treatment improves outcome after PCI
Personalized antiplatelet treatment leads to better outcomes than standard antiplatelet treatment in patients undergoing coronary stent implantation, according to results from the MADONNA study presented at ESC Congress 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 Günter 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?"
Provided by
European Society of Cardiology
-
Platelet function tests may provide modest benefit in predicting cardiac outcomes
Feb 23, 2010 |
not rated yet |
0
-
Antiplatelets: 1 person, 1 dose?
Apr 14, 2011 |
not rated yet |
0
-
Results of the TRIGGER-PCI trial reported at TCT 2011
Nov 09, 2011 |
not rated yet |
0
-
Half of patients undergoing cerebrovascular stent placement respond poorly to clopidogrel
Feb 05, 2008 |
not rated yet |
0
-
30-day results of ADAPT-DES registry reported at TCT 2011
Nov 09, 2011 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Solvability of a circuit
3 hours ago
-
Question about perception of colors around light sources
7 hours ago
-
Does a charged particle rotate when traveling through a static Bf?
9 hours ago
-
Find a link between physics and assignment problems
10 hours ago
-
Light as a source of electricity
10 hours ago
-
A question about the energy stored in a capacitor.
10 hours ago
- More from Physics Forums - Classical Physics
More news stories
Free fatty acids linked to cardiac risk in late adulthood
(HealthDay)—Blood levels of free fatty acids are associated with insulin resistance during young adulthood and cardiovascular risk factors in later adulthood, according to a study published online May 13 ...
Cardiology
May 17, 2013 |
not rated yet |
0
|
Diagnosing heart attacks: There's an app for that
An experimental, inexpensive iPhone application transmitted diagnostic heart images faster and more reliably than emailing photo images, according to a research study presented at the American Heart Association's Quality ...
Cardiology
May 17, 2013 |
not rated yet |
0
Study suggests new role for ECMO in treating patients with cardiac arrest and profound shock
Extracorporeal membrane oxygenation (ECMO), a procedure traditionally used during cardiac surgeries and in the ICU that functions as an artificial replacement for a patient's heart and lungs, has also been used to resuscitate ...
Cardiology
May 17, 2013 |
not rated yet |
0
Stroke patients respond similarly to after-stroke care, despite age difference
Age has little to do with how patients should be treated after suffering a stroke, according to new research from the University of Georgia.
Cardiology
May 17, 2013 |
not rated yet |
0
|
Depression linked to almost doubled stroke risk in middle-aged women
Depressed middle-aged women have almost double the risk of having a stroke, according to research published in Stroke: Journal of the American Heart Association.
Cardiology
May 16, 2013 |
not rated yet |
0
Researchers identify a potential new risk for sleep apnea: Asthma
Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...
Computational tool translates complex data into simplified 2-dimensional images
In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...
New theory on genesis of osteoarthritis comes with successful therapy in mice
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...
Study finds that sleep apnea and Alzheimer's are linked
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
'Gap' for HIV vaccine efforts after latest setback
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.
Ginger compounds may be effective in treating asthma symptoms
Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...