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Platelet Reactivity Levels May Predict Coronary Risk

Individualizing coronary intervention antithrombotic strategies may improve efficacy

FRIDAY, Sept. 26 (HealthDay News) -- High residual platelet reactivity after clopidogrel administration prior to percutaneous coronary intervention (PCI) is associated with higher incidence of 30-day major adverse cardiac events, according to a report published in the Sept. 30 issue of the Journal of the American College of Cardiology.

In a critical appraisal, Giuseppe Patti, M.D., of the University of Rome in Italy, and colleagues evaluated 160 patients with acute coronary syndromes. Using clopidogrel (a non-reversible P2Y12 platelet receptor inhibitor) prior to PCI, they measured the 30-day occurrence of major adverse cardiac events as the primary end point.

The study results indicated that high pre-PCI platelet reactivity after clopidogrel administration was associated with higher incidence of 30-day major adverse cardiac events, up to a sixfold increase. Higher P2Y12 reaction units score (240 or greater) correlated with lower clopidogrel activity and hence, greater risk, the researchers report. Age over 70 years, left ventricular dysfunction and use of glycoprotein IIb/IIIa inhibitors, unlike statins, also raised the risk, the report indicates.

In patients at higher risk, "individualized antithrombotic strategies (i.e., restricted use of drug-eluting stents, more extensive use of glycoprotein IIb/IIIa inhibitors, higher clopidogrel maintenance dose, or use of newer P2Y12 receptor antagonists) might be indicated to improve clinical outcome after coronary intervention," the authors write.

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