The Korean journal of internal medicine

  • 제26권2호
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  • Pages.145-152
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  • 2011
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Detection of Clopidogrel Hyporesponsiveness Using a Point-of-Care Assay and the Impact of Additional Cilostazol Administration after Coronary Stent Implantation in Diabetic Patients

  • Yang, Tae-Hyun (Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Busan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Doo-Il (Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Kim, Dong-Kie (Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Jang, Jae-Sik (Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Busan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Ung (Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Seol, Sang-Hoon (Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Kim, Dae-Kyeong (Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Busan Paik Hospital, Inje University College of Medicine) ;
  • Hong, Geu-Ru (Yeungnam University Medical Center) ;
  • Park, Jong-Seon (Yeungnam University Medical Center) ;
  • Shin, Dong-Gu (Yeungnam University Medical Center) ;
  • Kim, Young-Jo (Yeungnam University Medical Center) ;
  • Cho, Yun-Kyeong (Keimyung University Dongsan Medical Center) ;
  • Nam, Chang-Wook (Keimyung University Dongsan Medical Center) ;
  • Hur, Seung-Ho (Keimyung University Dongsan Medical Center) ;
  • Kim, Kwon-Bae (Keimyung University Dongsan Medical Center) ;
  • Kim, Dong-Soo (Division of Cardiology, Department of Internal Medicine & Cardiovascular Research Institute, Busan Paik Hospital, Inje University College of Medicine)
  • 발행 : 2011.06.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Impaired responsiveness to clopidogrel is common in patients with type 2 diabetes mellitus (DM). The aim of this study was to evaluate the clinical application of a point-of-care assay to detect impaired responsiveness to clopidogrel after coronary stent implantation in patients with type 2 DM. Methods: We measured P2Y12 reaction units (PRU) with the VerifyNow point-of-care assay in 544 consecutive patients undergoing dual or triple (i.e., dual plus cilostazol) anti-platelet therapy after coronary stent implantation. High platelet reactivity (HPR) was defined as a PRU value ${\geq}$ 240. Results: The mean PRU values were $233.5\;{\pm}\;83.2\;and\;190.3\;{\pm}\;85.5$ in patients undergoing dual or triple anti-platelet therapy, respectively (p < 0.001). Patients with DM manifested higher post treatment PRU values ($238.3\;{\pm}\;82.4\;vs.\;210.8\;{\pm}\;86.8$, p = 0.001) and a higher frequency of HPR (44.8% vs. 31.0%, p = 0.003) as compared to patients without DM. We also found that higher PRU values and a higher frequency of HPR were present in patients with DM who were undergoing both triple and dual anti-platelet therapy. However, the higher post-treatment PRU values observed in patients with DM decreased with triple anti-platelet therapy ($219.4\;{\pm}\;82.5\;vs.\;247.9\;{\pm}\;81.1$, p = 0.044). Conclusions: A point-of-care assay can detect elevated platelet reactivity and impaired responsiveness to clopidogrel in patients with type 2 DM. The addition of cilostazol to dual anti-platelet therapy may decrease post-treatment PRU values in patients with type 2 DM.

키워드

참고문헌

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피인용 문헌

  1. Comparison of On-Treatment Platelet Reactivity Between Triple Antiplatelet Therapy With Cilostazol and Standard Dual Antiplatelet Therapy in Patients Undergoing Coronary Interventions : A Meta-Analysi vol.18, pp.6, 2011, https://doi.org/10.1177/1074248413495971
  2. Dual Antiplatelet Therapy Clopidogrel with Low-dose Cilostazol Intensifies Platelet Inhibition in Patients with Ischemic Stroke vol.52, pp.10, 2013, https://doi.org/10.2169/internalmedicine.52.9550
  3. Comparing the effectiveness and safety between triple antiplatelet therapy and dual antiplatelet therapy in type 2 diabetes mellitus patients after coronary stents implantation: a systematic review an vol.15, pp.None, 2015, https://doi.org/10.1186/s12872-015-0114-1
  4. A pharmacodynamic study of the optimal P2Y 12 inhibitor regimen for East Asian patients with acute coronary syndrome vol.30, pp.5, 2015, https://doi.org/10.3904/kjim.2015.30.5.620
  5. Platelet Function Testing for Cardiac Surgery Patients on Antiplatelet Therapy: The Extreme Variability of Point-Of-Care Tests vol.11, pp.2, 2011, https://doi.org/10.13005/bpj/1412
  6. Cangrelor or Clopidogrel in Patients with Type 2 Diabetes Mellitus Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials vol.10, pp.3, 2011, https://doi.org/10.1007/s13300-019-0593-7