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Stent Thrombosis Patients with Hyporesponsiveness to Clopidogrel, Prasugrel, and Ticagrelor: A Case Series Using
Bartosz Olechowski1, Alexander Ashby1, Nalyaka Sambu1
1Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Insights
Patients with stent thrombosis (ST) after coronary intervention may not respond to common antiplatelet drugs. This study highlights cases of hyporesponsiveness to clopidogrel, prasugrel, and ticagrelor, indicating a need for further investigation.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis
Background:
- Patients undergoing percutaneous coronary intervention (PCI) with stent implantation are at risk of ischemic events, especially stent thrombosis (ST).
- Functional hyporesponsiveness to P2Y12 inhibitors is a known risk factor for ST.
- Current practice does not routinely assess antiplatelet drug response.
Purpose of the Study:
- To report cases of patients with ST who exhibit hyporesponsiveness to multiple P2Y12 inhibitors.
- To highlight the potential for broad hyporesponsiveness to common antiplatelet agents.
Main Methods:
- Case series reporting on patients with a history of stent thrombosis.
- Clinical observation of antiplatelet drug response.
Main Results:
- Three cases are presented where patients with ST showed hyporesponsiveness to clopidogrel.
- These same patients also exhibited hyporesponsiveness to prasugrel and ticagrelor.
Conclusions:
- Functional hyporesponsiveness to P2Y12 inhibitors, including newer agents like prasugrel and ticagrelor, can occur in patients with stent thrombosis.
- This suggests a potential for broad drug resistance in certain patient populations, necessitating further research into diagnostic and therapeutic strategies.
Abstract:
Patients after percutaneous coronary intervention (PCI) with stent implantation and functional hyporesponsiveness to P2Y12 inhibitors are at higher risk of ischaemic events, particularly stent thrombosis (ST). It is currently not routine practice to assess the functional response to these agents. However, concern over functional hyporesponsiveness to clopidogrel has led to widespread uptake of prasugrel and ticagrelor as the default P2Y12 inhibitor after stent implantation in patients with acute coronary syndrome. Here we report, for the first time, 3 cases in which patients who have had ST exhibit hyporesponsiveness to clopidogrel, prasugrel, and ticagrelor.
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