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Successful Therapy With Ticagrelor in Three-Vessel Stent Thrombosis Related to Clopidogrel Resistance
Seung-Yul Lee1, Jae Young Cho1, Kyeong Ho Yun1
1Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea.
Insights
Clopidogrel resistance caused stent thrombosis in a patient despite dual antiplatelet therapy. Switching to ticagrelor resolved the issue, suggesting tailored antiplatelet therapy may be beneficial.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is standard post-PCI to prevent stent thrombosis.
Observation:
- A 65-year-old male patient experienced 3-vessel stent thrombosis despite receiving aspirin and clopidogrel.
- Platelet function testing identified resistance to clopidogrel.
Findings:
- The patient's clopidogrel resistance resolved upon switching antiplatelet medication to ticagrelor.
- This switch successfully managed the stent thrombosis.
Implications:
- While routine platelet testing post-stenting is not standard, it can be valuable in refractory cases.
- Identifying specific antiplatelet drug resistance can guide personalized therapy to prevent stent thrombosis.
- Ticagrelor may be a viable alternative for patients exhibiting clopidogrel resistance.
Abstract:
A 65-year-old man developed 3-vessel stent thrombosis after percutaneous coronary intervention with aspirin and clopidogrel. Platelet tests revealed clopidogrel resistance, which resolved after changing clopidogrel to ticagrelor. Although routine platelet tests after stenting are not recommended, these tests may be considered to identify the cause of stent thrombosis and modify antiplatelet therapy.
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