Resistance to thienopyridines: clinical detection of coronary stent thrombosis by monitoring of vasodilator-stimulated phosphoprotein phosphorylation.
We carried out a prospective evaluation of a new vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay in order to detect patients with high-risk coronary subacute stent thrombosis (SAT) despite thienopyridine regimen. Twenty healthy donors (group 1) without any medication were compared to 16 stented patients (group 2) treated by ticlopidin or clopidogrel initiated 2 days before stenting and aspirin (250 mg/day). No difference in platelet reactivity was noted between group 1 and group 2 treated only with aspirin (72.00% +/- 4.17% vs. 69.73% +/- 5.62%, respectively; P = NS). Significant differences were found between patients of group 2 treated with aspirin alone (69.73% +/- 5.62%), after 2.0 days (60.14% +/- 9.60%; P < 0.05), and after 4.8 +/- 1.3 days (48.37% +/- 11.19%; P < 0.05) with thienopyridine-aspirin. Among 1,684 consecutive stented patients, 16 patients who presented an SAT (group 3) were compared with 30 other stented patients free of SAT (group 4). We found a significant difference between group 3 (63.28% +/- 9.56%) and group 4 (39.80% +/- 10.9%; P < 0.0001). VASP phosphorylation analysis may be useful for the detection of coronary SAT.
Barragan
Paul
P
Department of Cardiology, Beauregard Private Hospital Center, Marseille, France. p.barragan.cuecv@easynet.fr
Bouvier
Jean-Louis
JL
Roquebert
Pierre-Olivier
PO
Macaluso
Gilles
G
Commeau
Philippe
P
Comet
Bertrand
B
Lafont
Antoine
A
Camoin
Laurence
L
Walter
Ulrich
U
Eigenthaler
Martin
M
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D001241:Aspirin / Q000008:administration & dosage; D016022:Case-Control Studies; D015815:Cell Adhesion Molecules / Q000032:analysis*; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000175:diagnosis / Q000517:prevention & control; D023921:Coronary Stenosis / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000517:prevention & control*; D004351:Drug Resistance; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008840:Microfilament Proteins; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010750:Phosphoproteins / Q000032:analysis*; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011292:Premedication; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D000098662:Vasodilator-Stimulated Phosphoprotein
D015815:Cell Adhesion Molecules; D008840:Microfilament Proteins; D010750:Phosphoproteins; D010975:Platelet Aggregation Inhibitors; D000098662:Vasodilator-Stimulated Phosphoprotein; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin