Do We Need Platelet Function Testing in Percutaneous Coronary Intervention?
A 68-year-old man was admitted for acute ST-elevation inferior myocardial infarction after right coronary artery stenting (3.0 x 18mm drug-eluting stent) four months ago. He had been taking 81 mg of aspirin and 75 mg of clopidogrel orally on a daily basis. He is treated for hypertension and hypercholesterolemia, but not diabetes. He does not smoke. The angiogram demonstrated thrombosis in the stent. He underwent thromboaspiration, intravascular ultrasound of the thrombosed stent and balloon high-pressure inflations with a 3.5 x 15mm NC balloon. Did this patient have clopidogrel (Plavix)/aspirin (ASA) resistant platelets? Should the future doses of clopidogrel/ASA be increased over the standard doses on presumption of insufficient platelet response to dual antiplatelet therapy? Should platelet function be routinely tested? Definition of Platelet Resistance It has been thought that platelet resistance to clopidogrel or aspirin is associated with, or even promotes, acute stent thrombosis.
A 68-year-old man was admitted for acute ST-elevation inferior myocardial infarction after right coronary artery stenting (3.0 x 18mm drug-eluting stent) four months ago. He had been taking 81 mg of aspirin and 75 mg of clopidogrel orally on a daily basis. He is treated for hypertension and hypercholesterolemia, but not diabetes. He does not smoke. The angiogram demonstrated thrombosis in the stent. He underwent thromboaspiration, intravascular ultrasound of the thrombosed stent and balloon high-pressure inflations with a 3.5 x 15mm NC balloon. Did this patient have clopidogrel (Plavix)/aspirin (ASA) resistant platelets? Should the future doses of clopidogrel/ASA be increased over the standard doses on presumption of insufficient platelet response to dual antiplatelet therapy? Should platelet function be routinely tested? Definition of Platelet Resistance It has been thought that platelet resistance to clopidogrel or aspirin is associated with, or even promotes, acute stent thrombosis.
