Abstract 15587: Impact of Acute Presentation on Point-of-Care Platelet Function Testing Among Patients Receiving Coronary Stents
Background: P2Y12 inhibition is a mainstay for managing patients receiving coronary stents. Balancing safety and efficacy by sufficient but not excessive platelet inhibition is a goal of such therapy. This may be assessed objectively via platelet function testing (PFT, e.g., VerifyNow®) with results expressed in platelet reactivity units (PRU). Currently, most clinical application of antiplatelet therapy is empirical, and optimal use of PFT is uncertain. The objectives of this analysis were to identify the influence of cardiovascular presentation on platelet reactivity among patients receiving clopidogrel or prasugrel and on achieving an optimal PRU.
Methods: We retrospectively analyzed VerifyNow® data on coronary stent patients from the Intermountain Healthcare system registry (N=167) stratified by acute coronary syndrome (ACS) or stable clinical presentation and by loading with clopidogrel or prasugrel. Platelet inhibition goal was PRU = 100-200.
Results: A total of 167 patients (age = 65±17 years, males = 72%, diabetes = 34%, ACS presentation = 65%) were studied. Results are shown in the Table.
Conclusion: Among patients receiving coronary stents, ACS presentation is associated with a significant reduction in the level of platelet inhibition produced by either clopidogrel or prasugrel and results in a high proportion of patients (especially those receiving clopidogrel) with inadequate platelet inhibition. This suggests that ACS patients may require more potent initial anti-platelet therapy and may be a group in which routine PRU monitoring may be especially useful. Conversely, titrating therapy to avoid excessively low PRU may improve safety in both patient groups, especially with prasugrel.
- © 2013 by American Heart Association, Inc.