Antiplatelet Direncinin Miyokard İnfarktüsü Sonrası Sol Ventrikül Trombüsü Gelişimine Etkisi: Prospektif, Gözlemsel, Vaka-kontrol Çalışması

Abstract

Objective: Left ventricular (LV) thrombus is a serious complication of acute myocardial infarction (MI). In this study, the effect of biochemical resistance to antiplatelet agents used after ST elevation MI on LV thrombus development was investigated. Material and Methods: Patients who were diagnosed with anterior MI and undergone primary percutaneous coronary intervention were included in this study. The patients were divided into two groups: Patients with thrombus (Group 1) and the patients without thrombus (Group 2). PFA-100 platelet analyzer was used to measure platelet reactivity. Clopidogrel resistance was defined as collagen adenosine 5-diphosphate closure time (COLL/ADP CT) <120 seconds and acetylsalicylic acid (ASA) resistance was defined as collagen epinephrine closure time (COLL/EPI CT) <180 seconds. Group 1 and Group 2 were compared with ASA and clopidogrel resistance. Results: The mean CT for COLL/EPI was similar in two groups (Group 1: 221.4±64.8 sec, Group 2: 217.7±70.2 sec; p=0.81). ASA resistance was detected in 24 (26.7%) patients in the whole patient group. There was no difference between the two groups in terms of ASA resistance [8 patients (26.7%) in Group 1, 16 patients (26.7%) in Group 2; p=1.0]. The mean closure times for COLL/ADP were similar in two groups (Group 1: 145.9±63.9 sec, Group 2: 155.9±63.9 sec; p=0.48). Clopidogrel resistance was detected in 27 (30%) patients in the whole patient group. There was no difference between two groups in terms of clopidogrel resistance [9 (30%) patients in Group 1, 18 (30%) patients in Group 2; p=1.0]. There was no difference between two groups in patients with both clopidogrel and aspirin resistance. Conclusion: In vivo resistance to dual antiplatelet therapy does not appear to be an effective mechanism in the development of LV thrombus after MI.