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Traditional clinical risk factors predict clopidogrel hypo-responsiveness in unselected patients undergoing

Hanna Ratcovich1, Lene Holmvang1, Pär Inge Johansson2

  • 1a Department of Cardiology , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark and.

Platelets
|May 1, 2015
PubMed

Insights

The PREDICT score effectively identifies patients at high risk for high platelet reactivity to clopidogrel after PCI. However, it shows a weaker correlation with aspirin response, suggesting targeted platelet function testing for high-risk individuals.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • High and low platelet reactivity (HPR/LPR) to clopidogrel and aspirin are linked to adverse events post-percutaneous coronary intervention (PCI).
  • Predictive clinical risk scores aim to stratify patient risk for tailored antiplatelet therapy.

Purpose of the Study:

  • To evaluate the PREDICT score's ability to identify patients with HPR and LPR following PCI.
  • To assess the correlation between the PREDICT score and platelet reactivity to clopidogrel and aspirin.

Main Methods:

  • 923 patients undergoing non-emergent PCI were enrolled.
  • Platelet reactivity was measured using Multiplate assays, defining HPR and LPR by upper and lower quintiles.
  • Patients were assigned PREDICT score points based on clinical factors: age, left ventricular function, kidney function, ACS, and diabetes.

Main Results:

  • A significant association was found between higher PREDICT scores and increased risk of HPR to clopidogrel (ADP).
  • The PREDICT score demonstrated an inverse relationship with LPR to clopidogrel (ADP).
  • No clear association was observed between the PREDICT score and HPR to aspirin (AA).

Conclusions:

  • The PREDICT score is valuable for identifying patients at high risk of HPR to clopidogrel, potentially guiding antiplatelet therapy selection.
  • The PREDICT score's utility in predicting aspirin response is limited.
  • Platelet function testing may be reserved for patients with a high clinical likelihood of HPR, as indicated by the PREDICT score.

Keywords:
ClopidogrelPCIPREDICT scoringhigh on-treatment platelet reactivitylow on-treatment platelet reactivityplatelet function testing

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