Abstract
Objectives: To evaluate Aspirin and Clopidogrel resistance/non-responders in patients with acute coronary syndrome (ACS) by using adenosine diposphate and aspirin tests. Methodology: In the study patients with ACS loaded with 300 mg of clopidogrel and 300 mg aspirin and patients on stable daily dose of 75 mg of clopidogrel (more than 3 days) underwent PCI. Response to clopidogrel and Aspirin was assessed by Adenosine Diphosphate (ADP) Test (20 µmol/L) and Aspirin Test (Acetyl Acid) (ASP) 20 µmol/L, respectively, using the Multiplate Platelet Function Analyzer (Dynabyte Medical, Munich, Germany). Results: Sixty four patients were included in this study out of which 57 were with ACS and 7 scheduled for percutaneous coronary intervention (PCI) electively. The proportion of Aspirin good responders and adequate responders were 76.56% and 18.75%, respectively while adequate response and good response to Clopidogrel accounted for 29.7 and 48.4%, respectively Hyperlipidaemia was only co-morbidity associated with higher AUC ADP value (p: 0.046). Hypertriglyceridaemia and serum calcium were weakly correlated with higher AUC ADP serum calcium r=0.08, triglyceride r=0.12. Patients admitted for scheduled PCI and on stable dose of 75mg clopidogrel exhibited lower AUC ADP value as compared to those admitted with acute coronary syndrome given loading dose of 300mg of Clopidogrel. Post loading dose measurement of anti-platelet therapy among ACS patients using the Multiplate Platelet Function Analyzer showed comparable results with other methods. Conclusions : As determined by Multiplate Platelet Function Analyzer, Aspirin resistance/non-responders in this study in acute coronary syndrome patients accounted for 4.69% while Non-responders in Clopidogrel was 21.9%.
Highlights
Anti-platelet therapy remains most important and effective management in prevention of important clinical complications of atherothrombosis namely acute coronary events, cerebral vascular accidents and all other thrombotic events
Independent T Test for the group of proton pump inhibitor, calcium channel blocker and statins users has no significant effect on the tests. This was cross-sectional prevalence study looking at the group of coronary heart disease patients presenting with acute coronary syndromes or electively admitted for percutaneous coronary intervention (PCI)
We included 7 patients of elective cases on stable dose of clopidogrel 75 mg daily to compare the platelet aggregation as compared to patients who were admitted with acute coronary syndrome (ACS) and loaded with 300 mg of clopidogrel
Summary
Anti-platelet therapy remains most important and effective management in prevention of important clinical complications of atherothrombosis namely acute coronary events, cerebral vascular accidents and all other thrombotic events. The Anti-platelet trials documented the effect of aspirin on more than 100,000 aspirin-treated patient and controls, highlighting 25% reduction of death, myocardial infarction and stroke in highrisk vascular patients, 48% reduction in vascular graft and arterial occlusion, 67% reduction of pulmonary embolism and 23% reduction of deep vein thrombosis.[1] A study conducted to compare the activity of clopidogrel and aspirin in ischaemic events showed the superiority of clopidogrel in preventing cardiovascular events.[2] Several trials has demonstrated the reduction of cardiovascular risks by dual anti-platelet therapy with the combination of aspirin and clopidogrel, a theinopyridine that causes irreversible inhibition of the platelet ADP receptor P2Ysub12.3-5 Platelet aggregometry is most often used to assess and measure platelet aggregation. Laboratory definitions of non-responders have varied according to the platelet function tests used, and no study has prospectively validated conventional platelet aggregometry as an independent predictor of subsequent serious vascular events.[6]
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